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JCI  CCM    IBRARY 


CALIFORNIA  COLLEGE  OF  MEDICINE 


NATURE  IN  DISEASE. 


NATURE  IN  DISEASE; 


ILLUSTRATED   IN 


TO   WHICH   ABE   ADDED 


MISCELLANEOUS  WRITINGS, 

CHIEFLY   ON  MEDICAL  SUBJECTS. 


BY  JACOB  BIGELOW,   M.  D. 

PHYSICIAN  AND  LECTURER  ON   CLINICAL  MEDICINE  IN  THE  MASSACHUSETTS 

GENERAL    HOSPITAL;    PROFESSOR    OF  MATERIA  MEDICA  IN  HARVARD 

UNIVERSITY;    PRESIDENT    OF  THE  AMERICAN  ACADEMY  OP 

ARTS    AND    SCIENCES  ;    AND    LATE    PRESIDENT    OF 


SECOND   EDITION,  ENLARQED. 


BOSTON: 
PHILLIPS,   SAMPSON   AND    COMPANY. 

MDCCCLIX. 


Entered  according  to  Act  of  Congress,  in  the  year  1858,  by 

JACOB    BIGELOW, 
In  the  Clerk's  Office  of  the  District  Court  of  the  District  of  Massachusetts. 


Stereotyped    by 
HOBART   4    BOBBINS, 
Ktw  England  Type  and  Stereotjpe  Foun 


ROBLEY  DUNGLISON,  M.  D., 

PBOrzssOK  or  THE  INSTITUTES  or  MEDICINE,  ix  THE  JEFFERSON  MEDICAL 

COLLEGE,   PHILADELPHIA,  ETC.  ETC. 


Mr  DEAR  SIB  : 

I  am  sore  that  you  will  unite  with  me  in  admitting  that  the 
experience  of  a  long  professional  life  is  the  best  corrective  of  the 
exaggerated  estimate  which  we  are  liable  to  form,  or  imbibe,  in 
our  earlier  years,  as  to  the  power  of  medication  to  control  dia- 


I  inscribe  to  you  this  new  edition  of  a  work,  —  parts  of  which 
were  published  long  ago,  —  in  token  of  my  recognition  of  the  dis- 
tinguished rank  which  you  hold  as  one  of  the  medical  lights  of  our 
country,  and  of  my  satisfaction  in  knowing  that  you  concur  with 
me  in  the  principles  laid  down  in  its  leading  chapters. 
I  am,  dear  sir, 

With  respect  and  regard, 

Your  friend  and  servant, 

JACOB  BIGELOW. 


PREFACE 

TO    THE    FIRST    EDITION. 


IT  is  observable  to  many  physicians  that  a  change  in  the 
mode  of  regarding  the  treatment  of  disease  has  come  over 
the  medical  world,  not  only  in  this  city,  but  in  various 
parts  of  the  United  States,  during  the  last  quarter  of  a  cen- 
tury. In  many  cases  a  practice  of  watching,  guiding,  and 
trusting  the  salutary  indications  of  nature,  has  taken  the 
place  of  more  active  interferences  of  art.  Those  men 
whose  medical  career  began  at  a  period  antecedent  to 
that  which  has  been  named,  will  recollect  that  the  course 
then  most  prevalent  among  the  profession  consisted  in 
energetic  and  sometimes  annoying  and  painful  applica- 
tions of  supposed  remedies,  from  the  beginning  to  the 
end  of  diseases,  whether  those  diseases  were  amenable  to 
such  treatment,  or  totally  incapable  of  being  influenced 
by  them.  And,  in  some  instances,  such  active  measures 
were  promoted  by  influential  teachers  of  medical  science 
in  the  great  schools  of  our  country. 


VIII  PEEFACE. 

Nearly  twenty  years  ago  the  Discourse  on  Self-limited 
Diseases,  which  stands  at  the  head  of  this  volume,  was 
delivered  before  the  Massachusetts  Medical  Society,  at 
their  annual  meeting,  as  an  expression  of  opinions  I  had 
been  led  to  entertain  as  to  the  influence  of  treatment  on 
the  event  of  some  morbid  affections.  Subsequent  observa- 
tion has  not  tended  to  shake  these  opinions;  and  I  have 
had  the  satisfaction  to  believe  that  many  of  my  medical 
friends,  for  whose  judgment  the  public  entertain  the 
highest  respect,  have  arrived  at  similar  conclusions.  As 
science  has  advanced,  some  revision  has  become  necessary 
of  this  as  well  as  of  some  other  essays,  written  long  ago. 
But  the  general  truth  of  the  positions  then  assumed  has 
not  been  contradicted  by  later  experience  of  competent 
observers  in  the  profession. 

The  exclusive  pursuit  of  any  profession  frequently  tends 
to  an  undue  exaggeration  of  its  powers.  What  we  have 
been  early  taught  to  accept  on  authority,  and  what  we 
have  been  accustomed  habitually  to  announce  to  others, 
may  become  engrafted  on  our  own  belief,  so  as  to  consti- 
tute an  unquestioned  rule  of  practice.  The  necessity  is, 
on  this  account,  more  imperative,  that  inquirers  for  truth 
should  divest  themselves  of  personal  considerations,  and 
seek  for  rules  of  practice  which  are  based  on  enlightened 
experience,  and  impartial  and  reliable  evidence. 

I  have  given  the   title   "  Nature  in   Disease "  to  the 


PREFACE.  IX 

present  collection  of  discourses  and  disquisitions,  because 
a  number  of  the  principal  articles  in  its  contents  bear 
directly  on  that  subject.  But  I  have  taken  advantage 
of  the  same  occasion  to  incorporate  in  this  small  volume 
some  other  miscellaneous  papers,  chiefly  on  medical  sub- 
jects, written  or  published  at  various  times  during  a  long 
and  not  inactive  professional  life.  J.  B. 

BOSTON,  Nov.  1,  1854. 


PREFACE 

TO    THE    SECOND    EDITION. 


THE  reception  given  to  the  first  issue  of  this  collec- 
tion of  Discourses  and  Essays  has  been  thought  by  the 
publishers  to  authorize  the  stereotyping  of  its  pages,  and 
the  enlarging  of  their  number  with  some  additional  arti- 
cles on  medical  subjects  of  interest. 

In  a  little  work  lately  published,  entitled  "  Brief  Expo- 
sitions of  Rational  Medicine,"  to  which  the  reader  is 
referred,  I  have  endeavored  to  compare  and  define  the 
prominent  modes  of  practice  which  prevail  at  the  present 
day, —  the  Artificial,  the  Expectant,  the  Homoeopathic,  the 
Exclusive,  and  the  Rational. 

Since  the  publication,  in  1835,  of  the   Discourse   on 


X  PREFACE. 

Self-limited  Diseases,  which  stands  at  the  head  of  this 
volume,  public  opinion  in  this  part  of  the  country  seems 
to  have  undergone  progressive  modification  in  regard  to 
the  treatment  of  disease.  At  the  same  time  unequivocal 
manifestations  are  appearing  on  both  sides  of  the  Atlantic 
that  more  of  forbearance,  and  less  of  troublesome  inter- 
ference, are  required  in  medical  practice  than  was  formerly 
believed  to  be  necessary  by  a  majority  of  the  profession. 
BOSTON,  Jan.  1,  1859. 


CONTENTS. 


I.                                                     Page 
On  SELF-LIMITED  DISEASES, 13 

II. 
Ox  THE  TREATMEXT  OP  DISEASE, 64 

III. 

PRACTICAL  VIEWS  OF  MEDICAL  EDUCATION, 95 

IV. 
REPORT  ON  HOMOSOPATHY, 104 

V. 

Ox  THE  MEDICAL  PROFESSION,  AND  QUACKERY, 113 

VI. 

ON  GOUT  AND  ITS  TREATMENT, 134 

VII. 
APHORISMS  ox  CHOLERA,     147 

VIII. 

ON   THE   TREATMENT   OF  INJURIES  OCCASIONED   BY   FIRE  AND 
.  HEATED  SUBSTANCES, 151 

IX. 

Ox  THE  BURIAL  OF  THE  DEAD,  AND  THE  CEMETERY  AT  MOUNT 
AUBURN, 176 

X. 

THE  DEATH  OF  PLINY  THE  ELDER, 199 


XTT  CONTENTS. 

XI. 

REMARKS  AND  EXPERIMENTS  ON  PNEUMOTHOBAX, 210 

XII. 

ON  THE  PHARMACOPEIA  OF  THE  UNITED  STATES, 246 

XIII. 

ON  THE  MUCUNA  PRURIENS  :  WITH  REMARKS  ox  THE  IRRITA- 
BILITY OF  DIFFERENT  TEXTURES, 281 

XIV. 

ON  THE  POISONOUS  EFFECTS  OF  THE  AMERICAN  PARTRIDGE,  OR 
RUFFED  GROUSE, 287 

XV. 

OH  COFFEE  AND  TEA  ;  AND  THEIR  MEDICINAL  EFFECTS,  .•  .   .   .  304 

XVI. 

REPORT  OF  THE  ACTION  OF  COCHITUATE  WATER  ON  LEAD  PIPES; 

AND  THE  INFLUENCE  OF  THE  SAME  ON  HEALTH, 329 

XVII. 

OH  THE  POISONOUS  PROPERTIES  OF  CERTAIN  AMERICAN  SPECIES 
OF  RHUS, 337 

X  V  1 1 1  . 
ON  THE  HISTORY  AND  USE  OF  TOBACCO, 344 

XIX. 

OH  THE  EARLY  HISTORY  OF  MEDICINE, 358 

XX. 

ADDRESS  DELIVERED  BEFORE  THE  AMERICAN  ACADEMY  OF  ARTS 
AND  SCIENCES,  AT  THE  OPENING  OF  THEIR  COURSE  OF  LEC- 
TURES, OCTOBER  27,  1852 378 


ON 

SELF-LIMITED     DISEASES 

A  DISCOUBSE  DELIVERED  BEFORE   THE   5IASSACHUSETTS    MEDICAL 
SOCIETY,  AT  THEIR  ANXUAL  MEETING,    3IAT   27TH,  1885. 


[At  the  beginning  of  this  discourse,  the  customary  obituary  notice 
was  taken  of  eminent  members  of  the  society,  deceased  dur- 
ing the  previous  year.] 

THE  death  of  medical  men  is  an  occurrence 
which  eminently  demands  our  attention,  for  it 
speaks  to  us  of  our  science,  and  of  ourselves. 
It  reminds  us  that  we,  in  turn,  are  to  become 
victims  of  the  incompetency  of  our  own  art.  It 
admonishes  us  that  the  sphere  of  our  profes- 
sional exertions  is  limited,  at  last,  by  insurmount- 
able barriers.  It  brings  with  it  the  humiliating 
conclusion,  that  while  other  sciences  have  been 
carried  forward,  within  our  own  time  and  almost 
under  our  own  eyes,  to  a  degree  of  unprece- 
dented advancement,  Medicine,  in  regard  to  some 
of  its  professed  and  most  important  objects,  is 
2 


14  SELF-LIMITED  DISEASES. 

still  an  ineffectual  speculation.  Observations  are 
multiplied,  but  the  observers  disappear,  and  leave 
their  task  unfinished.  We  have  seen  the  matur- 
ity of  age  and  the  ardent  purpose  of  youth 
called  off  from  the  half  cultivated  field  of  their 
labors,  expectations,  and  promise.  It  becomes 
us  to  look  upon  this  deeply  interesting  subject 
with  unprejudiced  eyes,  and  to  endeavor  to  elicit 
useful  truth  from  the  great  lesson  that  surrounds 
us. 

In  comparing  the  advances  which  have  been 
made  during  the  present  age  in  different  depart- 
ments of  Medical  science,  we  are  brought  to  the 
conclusion  that  they  have  not  all  been  cultivated 
with  equally  satisfactory  success.  Some  of  them 
have  received  new  and  important  illustrations 
from  scientific  inquiry,  but  others  are  still  sur- 
rounded with  their  original  difficulties.  The 
structure  and  functions  of  the  human  body,  the 
laws  which  govern  the  progress  of  its  diseases, 
and  more  especially  the  diagnosis  of  its  morbid 
conditions,  are  better  understood  now  than  they 
were  at  the  beginning  of  the  present  century. 
But  the  science  of  therapeutics,  or  the  branch 
of  knowledge  by  the  application  of  which  physi- 


SELF-LIMITED  DISEASES.  15 

cians  are  expected  to  remove  diseases,  has  not, 
seemingly,  attained  to  a  much  more  elevated 
standing  than  it  formerly  possessed.  The  rec- 
ords of  mortality  attest  its  frequent  failures,  and 
the  inability  to  control  the  event  of  diseases, 
which  at  times  is  felt  by  the  most  gifted  and 
experienced  practitioners,  gives  evidence  that, 
in  many  cases,  disease  is  more  easily  understood 
than  cured. 

This  deficiency  of  the  healing  art  is  not  justly 
attributable  to  any  want  of  sagacity  or  diligence 
on  the  part  of  the  medical  profession.  It  be- 
longs rather  to  the  inherent  difficulties  of  the 
case,  and  is,  after  abating  the  effect  of  errors  and 
accidents,  to  be  ascribed  to  the  apparent  fact, 
that  certain  morbid  processes  in  the  human  body 
have  a  definite  and  necessary  career,  from  which 
they  are  not  to  be  diverted  by  any  known  agents 
with  which  it  is  in  our  power  to  oppose  them. 
To  these  morbid  affections,  the  duration  of 
which,  and  frequently  the  event  also,  are  beyond 
the  control  of  our  present  remedial  means,  I 
have,  on  the  present  occasion,  applied  the  name 
of  Self-limited  diseases  ;  and  it  will  be  the  object 
of  this  discourse  to  endeavor  to  show  the  exist- 


16  SELF-LIMITED   DISEASES. 

ence  of  such  a  class,  and  to  inquire  how  far  cer- 
tain individual  diseases  may  be  considered  as 
belonging  to  it. 

By  a  self-limited  disease,  I  would  be  under- 
stood to  express  one  which  receives  limits  from 
its  own  nature,  and  not  from  foreign  influences ; 
one  which,  after  it  has  obtained  foothold  in  the 
system,  cannot,  in  the  present  state  of  our 
knowledge,  be  eradicated  or  abridged  by  art,  — 
but  to  which  there  is  due  a  certain  succession  of 
processes,  to  be  completed  in  a  certain  time ; 
which  time  and  processes  may  vary  with  the 
constitution  and  condition  of  the  patient,  and 
may  tend  to  death,  or  to  recovery,  but  are  not 
known  to  be  shortened,  or  greatly  changed,  by 
medical  treatment. 

These  expressions  are  not  intended  to  apply 
to  the  palliation  of  diseases,  for  he  who  turns  a 
pillow,  or  administers  a  seasonable  draught  of 
water  to  a  patient,  palliates  his  sufferings ;  but 
they  apply  to  the  more  important  consideration 
of  removing  diseases  themselves  through  medi- 
cal means. 

The  existence  of  a  class  of  diseases  like  those 
under  consideration  is,  to  a  certain  extent. 


SELF-LOOTED   DISEASES.  17 

already  admitted,  both  by  the  profession  and  the 
public ;  and  this  admission  is  evinced  by  the  use 
of  certain  familiar  terms  of  expression.  Thus, 
when  people  speak  of  a  "  settled  disease/'  or  of 
the  time  of  "  the  run  of  a  disease,"  it  implies,  on 
their  part,  a  recognition  of  the  law  that  certain 
diseases  regulate  their  own  limits  and  period  of 
continuance. 

It  is  difficult  to  select  a  perfectly  satisfactory 
or  convincing  example  of  a  self-limited  disease 
from  among  the  graver  morbid  affections,  be- 
cause in  these  affections  the  solicitude  of  the 
practitioner  usually  leads  him  to  the  employ- 
ment of  remedies,  in  consequence  of  which  the 
effect  of  remedies  is  mixed  up  with  the  phenom- 
ena of  disease,  so  that  the  mind  has  difficulty  in 
separating  them.  [Note  A.]  We  must,  there- 
fore, seek  for  our  most  striking  or  decisive  exam- 
ples among  those  diseases  which  are  sufficiently 
mild  not  to  be  thought  to  require  ordinarily  the 
use  of  remedies,  and  in  which  the  natural  his- 
tory of  the  disease  may  be  observed,  divested  of 
foreign  influences.  Such  examples  are  found  in 
the  vaccine  disease,  the  chicken-pox,  and  the 

salivation    produced    by   mercury.      These   are 
'->* 


18  SELF-LIMITED   DISEASES. 

strictly  self-limited  diseases,  having  their  own 
rise,  climax,  and  decline ;  and  I  know  of  no 
medical  practice  which  is  able,  were  it  deemed 
necessary,  to  divert  them  from  their  appropriate 
course,  or  hasten  their  termination.  [Note  B.] 

It  may  appear  to  some  that  the  distinction  of 
these  diseases  from  others  is  the  old  distinction 
of  acute  and  chronic.  Yet,  on  due  inquiry,  such 
an  identification  is  not  found  to  be  sustained,  for 
there  are  some  acute  diseases  which,  we  have 
reason  to  believe,  are  shortened  by  the  employ- 
ment of  remedies;  while,  on  the  other  hand, 
certain  chronic  cases  of  disease  are  known  to 
get  well  spontaneously,  after  years  of  continu- 
ance. 

If  the  inquiry  be  made,  why  one  disease  has 
necessary  limits  while  another  is  without  them, 
the  reply  is  not  uniform,  nor  always  easy  to  be 
made.  Sometimes  the  law  of  the  disease  may 
be  traced  to  the  nature  of  the  exciting  cause. 
Thus  the  morbid  poison  of  measles,  or  of  small- 
pox, when  received  into  the  body,  produces  a 
self-limited  disease;  but  the  morbid  poisons  of 
psora  and  syphilis  may  give  rise  to  others  which 
are  not  limited,  except  by  medical  treatment. 


SELF-LIMITED  DISEASES.  19 

[Note  C.]  Sometimes,  also,  the  cause  being  the 
same,  the  result  will  depend  on  the  part,  organ, 
or  texture  which  is  affected.  Thus,  if  we  divide 
with  a  cutting  instrument  the  cellular  or  muscu- 
lar substance,  we  produce  a  self-limited  disease, 
which,  although  it  cannot  by  any  art  be  healed 
within  a  certain  number  of  days  or  weeks,  yet  in 
the  end  gets  well  spontaneously,  by  one  process, 
if  the  lips  are  in  contact,  and  by  another  and 
slower  process  if  they  are  separated.*  But  if, 
on  the  other  hand,  we  divide  a  considerable 
artery,  we  have  then  an  unlimited  disease ;  and 
the  hemorrhage,  or  the  aneurism,  which  follows, 
does  not  get  well,  except  through  the  interposi- 
tion of  art. 

The  class  of  diseases  under  consideration 
comprehends  morbid  affections,  differing  greatly 
from  each  other  in  the  time,  place,  and  nature  of 
their  spontaneous  developments;  so  that  they 
may  admit  of  at  least  three  general  subdivisions. 
These  maybe  called,  1st.  The  simple;  in  which 
the  disease  observes  a  continuous  time,  and 
mostly  a  definite  seat ;  2d.  The  paroxysmal ;  in 

*  In  one  case,  the  disease  is  a  solution  of  continuity  ;   in  the 
other,  a  solution  of  continuity  and  contact 


20  SELF-LIMITED   DISEASES. 

which  the  disease,  having  apparently  disap- 
peared, returns  at  its  own  periods ;  and,  3d.  The 
metastatic;  in  which  the  disease  undergoes  me- 
tastasis or  spontaneous  change  of  place.  In  the 
present  state  of  our  knowledge,  we  have  no  diffi- 
culty in  finding  examples  of  each  of  these  sub- 
divisions. There  are  also  other  examples,  in 
which  the  disease,  although  capable  of  being  in 
part  influenced  by  medical  treatment,  still  retains 
a  portion  of  its  original  intractability,  and  has 
strong  relations  to  the  class  in  question. 

As  a  mode  of  directing  our  inquiries  toward 
these  diseases,  we  may  suspect  those  complaints 
to  be  self-limited  in  which  it  is  observed  that  the 
unwary  and  the  sceptical,  who  neglect  to  resort 
to  remedies,  recover  their  health  without  them. 
We  may  also  suspect  diseases  to  be  of  this  char- 
acter when  we  find  opposite  modes  of  treatment 
recommended,  and  their  success  vouched  for,  by 
practitioners  of  authority  and  veracity.  We 
may,  moreover,  attach  the  same  suspicion  to 
cases  in  which  the  supposed  cure  takes  place 
under  chance  applications,  or  inconsiderable  rem- 
edies ;  as  in  the  empirical  modes  of  practice  on 
the  one  hand,  and  the  minute  doses  of  the  homce- 


SELF-LIMITED   DISEASES.  21 

opathic  method  on  the  other.  Lastly,  we  may 
apprehend  that  cases  are  fatally  self-limited,* 
when  enlightened  physicians  die  themselves  of 
the  diseases  which  they  had  labored  to  illustrate, 
—  as  in  the  case  of  Corvisart,  Laennec,  Arm- 
strong, and  others.  [Note  D.] 

In  proceeding  to  enumerate  more  precisely 
some  of  the  diseases  which  appear  to  me  to  be 
self-limited  in  their  character,  I  approach  the 
subject  with  diffidence.  I  am  aware  that  the 
works  of  medical  writers,  and  especially  of  med- 
ical compilers,  teem  with  remedies  and  modes  of 
treatment  for  all  diseases;  and  that,  in  the  morbid 
affections  of  which  we  speak,  remedies  are  often 
urged  with  zeal  and  confidence,  even  though 
sometimes  of  an  opposite  character.  Moreover, 
in  many  places,  at  the  present  day,  a  charm  is 
popularly  attached  to  what  is  called  an  active, 
bold,  or  heroic  practice ;  and  a  corresponding 
reproach  awaits  the  opposite  course,  which  is 
cautious,  palliative,  and  expectant.  In  regard  to 

*  In  the  following  article  on  the  Treatment  of  Disease,  it  has 
been  found  convenient  to  divide  diseases  into  the  curable,  the  self- 
limited,  and  the  incurable.  In  a  general  sense,  however,  the  last 
term  falls  within  the  second. 


22  SELF-LIMITED  DISEASES. 

the  diseases  which  have  been  called  self-limited, 
I  would  not  be  understood  to  deny  that  reme- 
dies capable  of  removing  them  may  exist ;  I 
would  only  assert  that  they  have  not  yet  been 
proved  to  exist. 

Under  the  simple  self-limited  diseases,  we  may 
class  hooping-cough.  This  disease  has  its  regular 
increase,  height,  and  decline,  occupying  ordina- 
rily from  one  to  six  months,  but  in  some  mild 
cases  only  two  or  three  weeks.  During  this 
period,  medical  treatment  is  for  the  most  part  of 
no  avail.  Narcotic  appliances  may  diminish  the 
paroxysm,  but  without  abridging  the  disease. 
After  hooping-cough  has  reached  its  climax, 
change  of  air  sometimes  appears  to  hasten  con- 
valescence. Also  if  inflammatory,  or  other  mor- 
bid affections,  supervene  upon  the  pure  disease, 
they  may  become  subjects  for  medical  treatment. 
"With  these  exceptions,  hooping-cough  appears 
to  be  a  self-limited  disease. 

Most  of  the  class  of  diseases  usually  denomi- 
nated eruptive  fevers,  are  self-limited.  Measles. 
for  example,  is  never  known  to  be  cut  short  by 
art,  or  abridged  of  its  natural  career;  neither 
can  this  career  be  extended,  or  the  disease  kept 


SELF-LIMITED   DISEASES.  23 

in  the  system  beyond  its  natural  duration,  by  the 
power  of  medicine.  Scarlet  fever,  a  disease  of 
which  we  have  had  much  and  fatal  experience 
during  the  last  three  years,  is  eminently  of  the 
same  character.  The  reasons,  which  induce  me 
thus  to  regard  it,  are  the  following.  The  writ- 
ings of  medical  observers  agree  in  assigning 
to  it  a  common  or  average  period  of  duration, 
and  this  is  confirmed  by  the  observations  of 
practitioners  at  the  present  day.  From  this 
average  duration  and  character  there  are  great 
natural  deviations,  the  disease  being  sometimes 
so  slight  as  to  attract  the  notice  of  none  but 
medical  eyes,  and  sometimes  so  malignant  that 
treatment  is  admitted  to  be  hopeless.  The  modes 
of  treatment,  which  have  had  most  testimony  in 
their  favor,  are  various,  and  opposite.  By  Dr. 
Fothergill,  stimulants  were  relied  on;  by  Dr. 
Currie,  cold  water;  by  Dr.  Southwood  Smith, 
and  others,  blood-letting.  But  it  is  not  satisfac- 
torily shown  that  either  of  these  modes  of  prac- 
tice has  been  particularly  successful ;  for,  where 
the  writers  have  furnished  us  anything  like  defi- 
nite or  numerical  results,  it  does  not  appear  that 
the  mortality  was  less  in  their  hands  than  it  is 


24  SELF-LIMITED   DISEASES. 

among  those  who  pursue  a  more  expectant  prac- 
tice. The  post-mortuary  appearances,  which  in 
many  diseases  furnish  useful  lessons  for  practice, 
are  in  scarlet  fever  extremely  various  and  uncer- 
tain ;  and  sometimes  no  morbid  changes,  suffi- 
cient to  account  for  death,  can  be  discovered 
iu  any  of  the  vital  organs,  or  great  cavities. 
[Note  E.] 

SmaU-pox  is  another  example  of  the  class  of 
affections  under  consideration,  its  approach  and 
disappearance  being  irrespective  of  medical  prac- 
tice. It  may,  at  first  view,  appear  that  inocula- 
tion has  placed  artificial  limits  on  this  disease. 
But  it  must  be  recollected  that  inoculated  small- 
pox is  itself  only  a  milder  variety  of  the  same 
disease,  having  its  own  customary  limits  of  ex- 
tent and  duration,  which  are  fixed,  quite  as  much 
as  those  of  the  distinct  and  confluent  forms  of 
the  natural  disease. 

Erysipelas  is  an  eruptive  fever,  having  strong 
analogies  with  those  which  have  been  detailed. 
It  is  not  certain  that  art  can  very  materially 
affect  either  the  duration  or  the  extent  of  this 
malady.  If  a  physician  is  called  to  a  case  of  ery- 
sipelas, which  is  beginning  to  be  developed  upon 


SELF-LIMITED   DISEASES.  25 

a  part  of  the  face  ;  and  if  he  is  asked,  whether 
the  disease  will  extend  to  the  crown,  or  the  neck, 
or  to  the  right  ear,  or  the  left,  — he  cannot  tell. 
And  if  he  is  asked  to  prevent  it  from  visiting 
either  of  these  places,  I  know  of  no  satisfactory 
evidence  that  he  can  do  it.  Erysipelas,  however, 
in  a  great  number  of  simple,  or  exanthematous 
cases,  in  subjects  previously  healthy,  gets  well 
without  any  treatment ;  and  in  a  great  number 
of  deep-seated  and  phlegmonous  cases,  as  well 
as  those  in  which  vital  organs  are  affected,  it 
proves  fatal  under  the  most  approved  methods 
of  medical  and  surgical  practice.  It  is  true  that 
patients  have  recovered,  under  punctures,  inci- , 
sions,  and  cautery.  It  is  also  true  that  they 
have  died  under  the  same  operations,  so  that  it 
may  be  submitted  as  a  doubtful  point,  whether 
we  yet  possess  adequate  evidence  that  erysipelas 
is  not  also  a  self-limited  disease." 

It  is  a  question  of  great  interest  to  the  medical 
profession,  to  determine  whether  typhoid  fever  is 
a  disease  susceptible  of  control  from  medical 
means.  On  this  subject  no  one  now  doubts  that, 
if  the  disease  is  once  fairly  established  in  the 
system,  it  cannot  be  eradicated  by  art,  but  must 
3 


26  SELF-LIMITED   DISEASES. 

complete  a  certain  natural  course,  before  conva- 
lescence can  take  place.  But  a  question  still 
exists,  whether  this  disease  is  capable  of  being 
jugulated,  or  broken  up,  at  its  outset,  by  the 
early  application  of  remedies. 

It  must  be  allowed  that  attacks  of  disease  re- 
sembling those  of  typhoid  sometimes  speedily 
disappear  during  the  use  of  remedies ;  but  it  is 
by  no  means  certain  that  such  cases  are  actually 
cases  of  typhoid.  The  diagnosis  of  this  disease, 
during  the  first  day  or  two,  is  extremely  difficult, 
its  character  being  simulated  by  different  febrile 
and  inflammatory  affections  j  so  tjiat  if  a  patient, 
under  the  use  of  remedies,  succeeds  in  avoiding 
protracted  disease,  we  are  not  justified  in  saying 
that  the  disease  he  has  escaped  was  typhoid  or 
typhus  fever.  Andral,  whose  experiments  on 
the  different  modes  of  treatment  in  continued 
fever  are  very  extensive,  has  stated,  that  in  a 
number  of  cases,  observed  by  him,  in  which  the 
fever  was  sufficiently  intense,  the  disease  ceased 
in  twenty-four  or  forty-eight  hours,  without  any 
treatment,  except  that  of  rest  and  a  regulated 
diet.* 

*  Clinique  JHL  619. 


SELF-LIMITED   DISEASES.  27 

Moreover,  in  weighing  the  influence  of  treat- 
ment, it  ought  to  be  recollected,  that  during  the 
existence  of  any  prevailing  epidemic,  mild  cases, 
partaking  of  a  similar  character  to  that  of  the 
reigning  disease,  continually  appear  among  the 
less  susceptible  part  of  the  community.  Thus, 
cholera  is  attended  by  diarrhoea  or  cholerine, 
influenza  by  mild  catarrh,  small-pox  by  varioloid, 
scarlet  fever  by  slight  sore  throats  or  ephemeral 
eruptions,  &c.  Now,  although  these  cases  are  in 
reality  modified  examples  of  the  grave  diseases 
which  they  accompany,  yet  I  believe  that  no 
well-informed  physician  will  attribute  the  mild- 
ness or  shortness  of  their  character  to  his  own 
particular  practice. 

On  the  other  hand,  it  is  certain  that  cases  of 
real  typhoid  do  often  come  under  active  treat- 
ment at  an  early  stage,  without  being  broken  up, 
or  disarmed  of  their  appropriate  consequences. 
This  particularly  happens  when  the  disease  is 
endemic  in  families,  so  that  successive  cases 
begin,  as  it  were,  under  the  eye  of  the  attending 
physician,  who  has  every  possible  inducement  to 
detect  and  prevent  them,  if  he  can.  In  such 
families,  indeed,  it  will  sometimes  happen  that 


28  SELF-LIMITED   DISEASES. 

febrile  attacks  of  different  kinds,  consequent 
upon  fatigue  and  anxiety,  and  perhaps  partaking 
of  the  typhoid  character,  will  take  place  among 
the  friends  and  attendants  of  the  sick  ;  and  these 
may  disappear  speedily,  under  rest  and  evacua- 
tions. But  that  grave  and  specific  typhoid  fever 
will  thus  disappear,  is  a  point  of  which  we  as  yet 
want  proof.  That  it  sometimes  fails  to  disappear, 
we  have  abundant  proof. 

Typhoid  fever  has,  in  many  respects,  a  marked 
affinity  with  the  class  of  eruptive  fevers,  which 
are  supposed  to  depend  on  a  specific  morbid 
poison,  and  which  no  one  pretends  to  intercept 
after  the  body  has  become  infected  with  them. 
Scarlet  fever  and  measles,  for  example,  when 
once  established,  require  a  certain  number  of 
days  to  finish  their  course  ;  so  also  does  typhoid. 
Scarlet  fever  and  measles  can,  in  most  cases,  be 
had  but  once  during  life ;  but  to  this  general  rule 
there  are  exceptions.  The  same  is  precisely  true 
in  regard  to  typhoid.  The  contagiousness  of 
scarlet  fever  is  a  point  of  dispute  among  physi- 
cians ;  and  so  is  that  of  typhoid.  Scarlet  fever 
is  attended  by  an  eruption  on  the  skin.  Typhoid 
fever  also  has  for  one  of  its  most  constant  symp- 


SELF-LIMITED   DISEASES.  29 

toms  a  red,  lenticular  eruption,  consisting  of  a 
few  spattered  rose-colored  pimples,  appearing 
chiefly  on  the  trunk,  from  about  the  sixth  to 
the  nineteenth  day  of  the  disease.  There  also 
occurs,  in  most  subjects,  a  minute,  vesicular 
eruption  of  sudamina,  about  the  neck  and  else- 
where. In  scarlet  fever,  moreover,  certain  por- 
tions of  the  mucous  membrane  undergo  morbid 
alterations,  particularly  on  the  tonsils,  and  other 
parts  of  the  fauces,  and  these  frequently  degen- 
erate into  ulcers,  affecting  the  subjacent  text- 
ures. In  like  manner,  in  typhoid  fever,  the 
mucous  membrane  of  the  granular  patches  in 
the  small  intestines,  which  have  been  named 
after  the  anatomist  Peyer,  undergo  morbid 
changes,  and  these  changes  are  followed  by 
ulcerations,  and  sometimes  perforations  of  the 
intestine.  This  fact,  established  by  the  re- 
searches of  Louis  and  other  pathologists  in 
Paris,  has  been  abundantly  confirmed  by  post 
mortem  examinations  made  in  this  country  dur- 
ing the  last  few  years.*  If  it  be  objected  to  the 
proposed  classification  of  this  fever,  that  the 
taclies  are  sometimes  few  in  number,  or  wholly 

*  1835. 
3* 


30  SELF-LIMITED   DISEASES. 

absent :  it  is  equally  true,  that  the  pustules  of 
inoculated  small-pox  are  likewise  often  very  few, 
or  absent;  and  that  the  eruption  of  scarlatina 
sometimes  wholly  fails  to  appear.  The  sore 
throat  also  in  the  latter  disease  is  wanting  quite 
as  often,  to  say  the  least,  as  the  morbid  affection 
of  Peyer's  glands. 

Before  quitting  the  subject,  I  beg  leave  to 
introduce  the  opinion  of  one  or  two  medical 
writers,  in  regard  to  the  possibility  of  interrupt- 
ing or  breaking  up  this  disease  by  means  of  art. 
M.  Louis,  of  whose  researches  in  regard  to 
typhoid  fever  it  is  but  small  praise  to  say  that 
they  are  more  exact  and  comprehensive  than 
those  of  any  living  writer,  is  of  opinion  that  the 
disease  cannot  be  thus  intercepted.  "  Experi- 
ence," says  he,  "  has  shown,  that  a  well  marked 
typhoid  affection  is  not  capable  of  being  broken 
up."*  To  this  testimony  of  one  of  the  most 

*  "  L'experience  ayant  montre,  que  1'affection  typhoide  bien 
caracterisee,  n'est  pas  susceptible  d'etre  jugulee,  ce  qui  n'est 
guere  moins  Yrai,  d'ailleurs,  suivant  toutes  les  apparences,  de  la 
peripneumonie  et  des  autres  maladies  inflammatoires."  —  Louis, 
Gastro-enterite.  II.  512. 

Andral  says,  in  regard  to  the  different  modes  of  treatment  in 
typhus,  "  Quelles  que  soient  les  methodes  employees,  il  est  un 


SELF-LIMITED   DISEASES.  31 

eminent  teachers  in  the  French  metropolis  it 
may  not  be  amiss  to  add  that  of  an  American 
physician,  whose  opportunities  for  observing  the 
disease  in  different  parts  of  New  England  were 
extensive,  and  whose  Essay  on  Typhus  Fever 
well  merits  an  attentive  perusal.  The  late  Dr. 
Nathan  Smith,  in  the  course  of  some  remarks  on 
the  possibility  of  interrupting  this  disease  at 
commencement,  observes :  "  During  the  whole  of 
my  practice  I  have  never  been  satisfied  that  I 
have  cut  short  a  single  case  of  typhus  that  I 
knew  to  be  such."  * 

Having  said  thus  much,  I  leave  the  subject  of 
the  tractability  of  typhus  and  typhoid  fever  to 
the  light  of  future  investigation.  It  is  but  jus- 
tice to  state,  that  numerous  and  highly  respect- 
able authorities  are  declared  in  favor  of  the  effi- 
cacy of  art  in  shortening  and  mitigating  these 
diseases ;  and  it  will  be  a  source  of  gratification 

certain  nombre  de  cas  ou,  sans  que  ces  methodes  y  prennent  part, 
la-mature  conduit  la  maladie  a  une  terminaison  heureuse  ou 
funeste."  — Clinique  I.  651. 

*  At  the  time  of  the  publication  alluded  to,  the  distinction 
between  typhus  and  typhoid  fevers  had  not  been  well  made  out. 
The  distinction  is  good,  though  writers  of  authority  differ  on  the 
subject. 


32  SELF-LIMITED   DISEASES. 

to  the  friends  of  humanity  and  science,  should  it 
ultimately  be  settled,  that  the  active  treatment 
now  usually  pursued  at  the  commencement  of 
cases  is  instrumental  in  lessening  their  duration, 
severity,  or  danger. 

Among  the  morbid  affections  which  have  now 
been  enumerated  may  be  found  sufficient  exam- 
ples of  continued  diseases  which  receive  limits 
from  their  own  nature,  and  not  from  the  interfer- 
ence of  art.  Whether  the  number  of  these 
diseases  may  not  be  augmented  by  additions 
from  among  other  fevers  and  acute  inflamma- 
tions, I  am  not  prepared  to  decide.  It  is  diffi- 
cult, however,  to  withhold  the  belief  that  a  more 
extended  inquiry  must  probably  serve  to  multi- 
ply, rather  than  diminish,  the  number  of  maladies 
to  which  this  character  will  be  found  appropri- 
ate.* 

We    come   next  to   a   second   order   of   self- 

*  There  is  not  room  here  to  discuss  the  question  whether  Pneu- 
monia and  other  acute  inflammations  fall  under  the  category  of 
self-limitation.  Blood-letting,  in  proper  cases,  lessens  the  severity 
and  danger  of  these  diseases.  But  it  is  not  apparent  that  it 
greatly  abridges  their  duration.  Dysentery  may  be  accounted  a 
self-limited  disease. 


SELF-LIMITED   DISEASES.  33 

limited  diseases,  of  which  the  term  paroxysmal 
is  sufficiently  descriptive.  This  term  applies  to 
certain  morbid  affections,  which  occur  in  fits  or 
paroxysms,  leaving  the  patient  comparatively 
well  in  the  intervals,  at  the  same  time  that  the 
paroxysms  themselves  can  neither  be  foreseen, 
prevented,  nor,  as  far  as  we  know,  materially 
abridged  in  their  duration.  At  the  head  of  this 
subdivision  stands  Epilepsy,  a  disease  which  has 
long  been  eminent  as  an  opprobrium  of  medicine, 
and  for  which,  it  is  believed,  the  healing  art  has 
not  yet  devised  a  cure.  The  first  attacks  of 
epilepsy,  especially  while  there  is  any  doubt  as 
to  the  nature  of  the  malady,  are  usually  made  the 
subjects  of  active  and  various  treatment.  But 
after  the  recurring  paroxysms  have  established 
the  character  of  the  disease,  if  active  medical 
practice  is  persevered  in,  it  is  rather  to  satisfy 
the  anxiety  of  friends  than  the  judgment  of  the 
practitioner. 

Angina  pectoris,  appropriately  called  by  Dr. 
Good,  Sternalgia,  is  a  paroxysmal  disease,  which 
in  many  cases  controls  its  own  movements.  The 
anatomical  character  of  this  disease  is  not  uni- 
form, and,  I  may  add,  the  same  is  true  of  its 


34  SELF-LIMITED   DISEASES. 

medical  treatment.  And  in  this  place  it  may  be 
proper  to  state  that  various  incurable  lesions  of 
the  heart,  lungs,  brain,  and  other  viscera,  do  not 
apparently  destroy  life  by  a  regular,  undeviating 
march ;  but  that,  as  far  as  their  outward  phenom- 
ena afford  evidence,  they  seem  to  proceed  by 
alternate  fits  and  pauses,  undergoing,  in  their 
progress,  all  states  except  that  of  retrogradation. 
This  is  apparently  true  in  regard  to  tubercle, 
carcinoma,  ossification,  hypertrophy,  and  some 
other  morbid  alterations.  It  is  also  even  true 
in  regard  to  old  age  itself. 

Thirty  years  ago  we  might  have  added  gout 
to  the  opprobrious  list  under  consideration.  But 
as  we  may  now  be  said  to  possess  the  means  of 
shortening  the  paroxysms,  by  the  use  of  certain 
acrid  narcotics,  and  as  an  abstemious  life  goes 
far  towards  lessening  the  frequency  and  violence 
of  the  recurrence,  we  may  be  justified  in  with- 
drawing gout  from  the  place  it  would  otherwise 
occupy.  [Note  F.] 

The  diseases  of  mania  and  melancholy,  asthma, 
when  it  depends  on  emphysema  of  the  lungs, 
gravel  in  the  kidneys,  and  the  symptoms  pro- 
duced by  ascarides  in  the  rectum  [Note  G],  fur- 


SELF-LIMITED   DISEASES.  35 

nish  other  examples  of  maladies  which  manifest 
themselves  in  unforeseen  paroxysms.  Cases 
which  bear  the  names  of  all  the  above  diseases 
are  undoubtedly  relieved,  and  sometimes  even 
removed  by  medicine ;  but  it  is  equally  true  that 
other  cases  are  wholly  intractable,  both  as  to 
their  recurrence,  tneir  duration,  and  their  suscep- 
tibility of  much  change  from  medical  treatment. 
And  it  will  come  to  the  recollection  of  many 
practitioners,  that  they  have,  in  the  course  of 
their  lives,  believed  themselves  to  have  cured 
these  diseases,  when  in  fact  they  have  only  wit- 
nessed the  spontaneous  subsidence  of  a  par- 
oxysm. 

The  last  subdivision  of  our  Subject  includes 
what  may  be  called  metastatic  diseases.  By  this 
term  I  wish  to  express  certain  morbid  affections, 
which  pass  by  metastasis  from  one  part  of  the 
body  to  another,  for  the  most  part  independently 
of  artificial  influence.  Of  this  kind  are  certain 
cutaneous  affections,  more  especially  some  which 
are  chronic  and  hereditary.  Many  persons  pass 
a  considerable  portion  of  their  lives  in  alternate 
annoyance  from  a  disease  of  the  skin,  and  from 
its  vicarious  substitute  in  some  internal  organ. 


3G  SELF-LIMITED   DISEASES. 

Others  again  are  afflicted  with  hemorrhagic  or 
purulent  discharges,  which  at  times  disappear 
only  to  be  succeeded  by  equally  troublesome 
affections  in  a  different  part.  Gonorrhoea  cannot 
be  prevented  from  occasional  metastasis  of 
inflammation,  and  mumps  are  sometimes  found 
to  undergo  the  same  transition.  But  perhaps 
the  most  remarkable  example  of  a  metastatic 
disease  is  found  in  acute  rheumatism.  This 
morbid  affection  often  begins  to  discover  itself 
in  a  limited  and  comparatively  unimportant  part 
of  the  system.  From  thence,  in  grave  cases,  it 
travels  by  successive  migrations  from  joint  to 
joint,  and  from  limb  to  limb,  till  it  has  visited 
nearly  all  the  great  articulations  of  the  body. 
It  also  attacks  the  organs  of  sense,  and  the  vis- 
cera which  are  essential  to  life.  During  the 
course  of  these  migrations  the  attending  physi- 
cian cannot  foretell  at  any  given  stage  what  part 
will  be  next  invaded  by  the  disease,  neither  can 
he  protect  any  part  from  being  thus  invaded; 
nor  can  he  control  the  period  during  which  the 
disease  will  reside  in  any  particular  part  previ- 
ously to  its  next  metastasis.  Nevertheless  acute 
rheumatism  is  susceptible  of  great  palliation 


SELF-LIMITED   DISEASES.  37 

though  of  little  abridgment,  and,  after  having  run 
out  its  career,  terminates  in  spontaneous  recov- 
ery; not,  however,  in  some  cases,  until  it  has 
laid  the  foundation  of  serious  organic  derange- 
ments, especially  of  the  heart. 

I  forbear  to  dilate  on  the  structural  lesions  of 
different  organs,  many  of  which  can  only  be 
cured  by  the  extirpation  of  the  part  in  which 
they  reside,  thus  sacrificing  the  integrity  of  the 
body  to  the  preservation  of  life  ;  and  in  which 
extirpation  cannot  avail,  when  the  seat  of  the 
disease  is  in  a  vital  part.  I  also  pass  over  the 
pestilential  epidemics  of  plague,  yellow  fever, 
malignant  dysentery,  and  cholera ;  diseases  about 
which  the  medical  profession  have  great  differ- 
ences of  opinion,  and  of  which  thousands  die 
annually,  though  hundreds  of  volumes  have  been 
written  for  their  preservation.  [Note  H.] 

It  may  perhaps  appear  that  the  views  which 
have  now  been  iaken  of  the  power  of  medicine, 
in  so  large  a  class  of  diseases,  are  gloomy  and 
discouraging,  and  that  an  unworthy  tribute  is 
paid  to  the  labors  of  those  physicians  who  have 
patiently  studied  and  ardently  acted  for  the 
benefit  of  humanity.  Such  views,  however,  are 
4 


38  SELF-LIMITED   DISEASES. 

far  from  being  the  object  of  the  present  dis- 
course. "Were  it  permitted  by  the  compass  of 
the  subject  under  consideration,  it  would  be  a 
very  grateful  task  to  enumerate  those  maladies 
of  the  human  frame,  over  which  we  have  reason 
to  believe  that  medicine  has  obtained  decisive 
influence.  To  a  medical  audience,  it  is  unneces- 
sary to  recall  the  instances  of  pain  relieved, 
spasms  controlled,  inflammations  checked  [Note 
I],  and  diseased  associations  broken  up,  under 
limitable  diseases,  by  the  agency  of  the  healing 
art.  Were  there  no  other  trophy  for  the  medi- 
cal profession  to  boast,  it  is  sufficient  to  know 
that  the  diseases  of  small-pox  and  syphilis  alone 
would  have  entailed  misery  and  extermination 
on  a  large  portion  of  our  species,  had  not  med- 
ical science  discovered  the  prevention  of  the 
one,  and  the  successful  management  of  the 
other. 

But  that  the  usefulness  of  our  profession  may 
extend,  our  knowledge  must  go  on  to  mere; 
and  the  foundation  of  all  knowledge  is  truth. 
For  truth  then  we  must  earnestly  seek,  even 
when  its  developments  do  not  flatter  our  profes- 
sional pride,  nor  attest  the  infallibility  of  our  art. 


SELF-LIMITED   DISEASES.  39 

To  discover  truth  in  science  is  often  extremely 
difficult ;  in  no  science  is  it  more  difficult  than 
in  medicine.  Independently  of  the  common  de- 
fects of  medical  evidence,  our  self-interest7  our 
self-esteem,  and  sometimes  even  our  feelings  of 
humanity,  may  be  arrayed  against  the  truth.  It 
is  difficult  to  view  the  operations  of  nature, 
divested  of  the  interferences  of  art,  so  much  do 
our  habits  and  partialities  incline  us  to  neglect 
the  former,  and  to  exaggerate  the  importance  of 
the  latter.  The  mass  of  medical  testimony  is 
always  on  the  side  of  art.  Medical  books  are 
prompt  to  point  out  the  cure  of  diseases.  Medi- 
cal journals  are  filled  with  the  crude  productions 
of  aspirants  to  the  cure  of  diseases.  Medical 
schools  find  it  incumbent  on  them  to  teach  the 
cure  of  diseases.  The  young  student  goes  forth 
into  the  world,  believing  that  if  he  does  not  cure 
diseases,  it  is  his  own  fault.  Yet  when  a  score 
or  two  of  years  have  passed  over  his  head, 
he  will  come  at  length  to  the  conviction  that 
some  diseases  are  controlled  by  nature  alone. 
He  will  often  pause,  at  the  end  of  a  long  and 
anxious  attendance,  and  ask  himself  how  far  the 
result  of  the  case  is  different  from  what  it  would 


40  SELF-LIMITED   DISEASES. 

have  been  under  less  officious  treatment  than 
that  which  he  has  pursued ;  how  many  in  the 
accumulated  array  of  remedies,  which  have  sup- 
planted each  other  in  the  patient's  chamber,  have 
actually  been  instrumental  in  doing  him  any 
good.  He  will  also  ask  himself  whether,  in  the 
course  of  his  life,  he  has  not  had  occasion  to 
change  his  opinion,  perhaps  more  than  once,  in 
regard  to  the  management  of  the  disease  in  ques- 
tion, and  whether  he  does  not,  even  now,  feel 
the  want  of  additional  light. 

Medicine  has  been  rightly  called  a  conjectural 
art,  because  in  many  of  its  deductions,  and  espe- 
cially in  those  which  relate  to  the  cure  of  dis- 
eases, positive  evidence  is  denied  to  us.  We  are 
seldom  justified  in  concluding  that  our  remedies 
have  promoted  the  cure  of  a  disease,  until  we 
know  that  cases  exactly  similar  in  time,  place, 
and  circumstances,  have  failed  to  do  equally  well 
under  the  omission  of  those  remedies  ;  and  such 
cases,  moreover,  must  exist  in  sufficient  numbers 
to  justify  the  admission  of  a  general  law,  on  their 
basis.  Nothing  can  be  more  illogical  than  to 
draw  our  general  conclusions,  as  we  are  some- 
times too  apt  to  do,  from  the  results  of  insulated 


SELF-LIMITED   DISEASES.  41 

and  remarkable  cases ;  for  such  cases  may  be 
found  in  support  of  any  extravagance  in  medi- 
cine ;  and  if  there  is  any  point  in  which  the  vul- 
gar differ  from  the  judicious  part  of  the  profes- 
sion, it  is  in  drawing  premature  and  sweeping 
conclusions  from  scanty  premises  of  this  kind. 
Moreover,  it  is  in  many  cases  not  less  illogical  to 
attribute  the  removal  of  diseases,  or  even  of 
their  troublesome  symptoms,  to  the  means  which 
have  been  most  recently  employed.  It  is  a  com- 
mon error  to  infer  that  things  which  are  consec- 
utive in  the  order  of  time  have  necessarily  the 
relation  of  cause  and  effect.  It  often  happens 
that  the  last  remedy  used  bears  off  the  credit  of 
having  removed  an  obstruction,  or  cured  a  dis- 
ease, whereas  in  fact  the  result  may  have  been 
owing  to  the  first  remedy  employed,  or  to  the 
joint  effect  of  all  the  remedies,  or  to  the  act  of 
nature,  uninfluenced  by  any  of  the  remedies. 
"We  see  this  remarkably  exemplified  in  recoveries 
from  amenorrhoea,  and  from  various  irregularities 
of  the  alimentary  canal. 

An   inherent   difficulty,  which  every  medical 
man  finds  to  stand  in  the  way  of  an  unbiased 
and  satisfactory  judgment,  is  the  heavy  respoii- 
4* 


42  SELF-LIMITED   DISE^SES. 

sibility  which  rests  upon  the  issue  of  his  cases. 
When  a  friend,  or  valuable  patient,  is  committed 
to  our  charge,  we  cannot  stand  by,  as  curious 
spectators,  to  study  the  natural  history  of  his 
disease.  We  feel  that  we  are  called  on  to  at- 
tempt his  rescue  by  vigorous  means,  so  that  at 
least  the  fault  of  omission  shall  not  lie  upon  our 
charge.  We  proceed  to  put  in  practice  those 
measures  which  on  the  whole  have  appeared  to 
us  to  do  most  good ;  and,  if  these  fail  us,  we 
resort  to  other  measures,  which  we  have  read  of, 
or  heard  of.  And  at  the  end  of  our  attendance 
we  may  be  left  in  uncertainty  whether  the  dura- 
tion of  sickness  has  been  shortened,  or  length- 
ened, by  our  practice,  and  whether  the  patient  is 
really  indebted  to  us  for  good  or  evil.  In  the 
study  of  experimental  philosophy,  we  rarely  ad- 
mit a  conclusion  to  be  true,  until  its  opposite 
has  been  proved  to  be  untrue.  But  in  medicine 
we  are  often  obliged  to  be  content  to  accept  as 
evidence  the  results  of  cases,  which  have  been 
finished  under  treatment,  because  we  have  not 
the  opportunity  to  know  how  far  these  results 
would  have  been  different,  had  the  cases  been 
left  to  themselves.  And  it  too  frequently  hap- 


SELF-LIMITED   DISEASES.  43 

pens  that  medical  books  do  not  relieve  our  diffi- 
culties on  this  score,  for  a  great  deal  of  our  prac- 
tical literature  consists  in  reports  of  interesting, 
extraordinary,  and  successful  results,  published 
by  men  who  have  a  doctrine  to  establish,  or  a 
reputation  to  build.  "  Few  authors/7  says  An- 
dral,  "have  published  all  the  cases  they  have 
observed,  and  the  greater  part  have  only  taken 
the  trouble  to  present  to  us  those  facts  which 
favor  their  own  views.7'*  A  prevailing  error, 
among  writers  on  therapeutics,  proceeds  from 
their  professional  or  personal  reluctance  to  ad- 
mit that  the  healing  art,  as  practised  by  them,  is 
not,  or  may  not  be,  all-sufficient,  in  all  cases  ;  so 
that  on  this  subject  they  suffer  themselves,  as 
well  as  their  readers,  to  be  deceived.  Hence  we 
have  no  disease,  however  intractable  or  fatal,  for 
which  the  press  has  not  poured  forth  its  asserted 
remedies.  Even  of  late  we  have  seen  unfailing 
cures  of  cholera  successively  announced  in  almost 
every  city,  in  which  that  pestilence  unchecked 
has  completed  its  work  of  devastation  ! 

*  Bien  peu  d'auteurs  ont  publie  tous  les  cas  qu'ils  out  observes, 
et  la  plupart  ne  se  sont  empresses  de  nous  transmettre  que  les 
faits  que  caressaient  leurs  idees.  —  Clinique  HI.  618. 


44  SELF-LIMITED   DISEASES. 

It  is  only  when,  in  connection  with  these  flat- 
tering exhibitions,  we  have  a  full  and  faithful 
report  of  the  failures  of  medical  practice,  in  sim- 
ilar, and  in  common  cases,  setting  forth  not  only 
the  truth,  but  the  whole  truth,  that  we  have  a 
basis  sufficiently  broad  to  erect  a  superstructure, 
in  therapeutics,  on  which  dependence  may  be 
placed.  Such,  it  must  give  the  friends  of  science 
gratification  to  observe,  is  a  part  of  the  rigid 
method  which  characterizes  the  best  examples 
of  the  modern  French  school ;  and  such,  it  is  not 
difficult  to  foresee,  must  ultimately  be  the  only 
species  of  evidence  on  this  subject,  to  which  the 
medical  profession  will  pay  deference. 

It  appears  to  me  to  be  one  of  the  most  impor- 
tant desiderata  in  practical  medicine,  to  ascer- 
tain, in  regard  to  each  doubtful  disease,  how  far 
its  cases  are  really  self-limited,  and  how  far  they 
are  controllable  by  any  treatment.  This  ques- 
tion can  be  satisfactorily  settled  only  by  institut- 
ing, in  a  large  number  of  cases,  which  are  well 
identified  and  nearly  similar,  a  fair  experimental 
comparison  of  the  different  active  and  expectant 
modes  of  practice,  with  their  varieties  in  regard 
to  time,  order,  and  degree.  This  experiment  is 


SELF-LIMITED   DISEASES.  45 

vast,  considering  the  number  of  combinations 
which  it  must  involve  ;  and  even  much  more 
extensive  than  a  corresponding  series  of  patho- 
logical observations  ;  yet  every  honest  and  intel- 
ligent observer  may  contribute  to  it  his  mite.  Op- 
portunities for  such  observations,  and  especially 
for  monographs  of  diseases,  are  found  in  the 
practice  of  most  physicians,  yet  hospitals  and 
other  public  charities  aiford  the  most  appropri- 
ate field  for  instituting  them  upon  a  large  scale. 
The  aggregate  of  results,  successful  and  unsuc- 
cessful, circumstantially  and  impartially  reported 
by  competent  observers,  will  give  us  a  near 
approximation  to  truth,  in  regard  to  the  diseases 
of  the  time  and  place  in  which  the  experiments 
are  instituted.  The  numerical  method  employed 
by  Louis  in  his  extensive  pathological  researches, 
and  now  adopted  by  his  most  distinguished  con- 
temporaries in  France,  affords  the  means  of  as 
near  an  approach  to  certainty  on  this  head,  as 
the  subject  itself  admits.  And  I  may  add,  that 
no  previous  medical  inquirer  has  apparently  sub- 
mitted to  the  profession  any  species  of  evidence 
so  broad  in  its  foundations,  and  so  convincing  in 
its  results,  as  that  which  characterizes  the  great 


46  SELF-LIMITED   DISEASES. 

works  of  this  author  on  Phthisis  and  Typhoid 
fever. 

In  regard  to  acknowledged  self-limited  dis- 
eases, the  question  will  naturally  arise,  whether 
the  practitioner  is  called  on  to  do  nothing  for 
the  benefit  of  his  patient ;  whether  he  shall  fold 
his  hands,  and  look  passively  on  the  progress  of 
a  disease  which  he  cannot  interrupt.  To  this  I 
would  answer, — by  no  means.  The  opportuni- 
ties of  doing  good  may  be  as  great  in  these  dis- 
eases as  in  any  others ;  for,  in  treating  every 
disease,  there  is  a  right  method  and  a  wrong. 
In  the  first  place,  we  may  save  the  patient  from 
much  harm,  not  only  by  forbearing  ourselves  to 
afflict  him  with  unnecessary  practice,  but  also  by 
preventing  the  ill-judged  activity  of  others.  For 
the  same  reason  that  we  would  not  suffer  him  to 
be  shaken  in  his  bed,  when  rest  was  considered 
necessary  to  him,  we  should  not  allow  him  to  be 
tormented  with  useless  and  annoying  applica- 
tions in  a  disease  of  settled  destiny.  It  should 
be  remembered  that  all  cases  are  susceptible  of 
errors  of  commission,  as  well  as  of  omission,  and 
that,  by  an  excessive  application  of  the  means  of 
art,  we  may  frustrate  the  intentions  of  nature 


SELF-LIMITED   DISEASES.  47 

when  they  are  salutary,  or  embitter  the  approach 
of  death  when  it  is  inevitable.  What  practition- 
er, I  would  ask,  ever  rendered  a  greater  service 
to  mankind,  than  Ambrose  Pare,  and  his  subse- 
quent coadjutors,  who  introduced  into  modern 
surgery  the  art  of  healing  by  the  first  intention  ? 
These  men  with  vast  difficulty  succeeded  in  con- 
vincing the  profession,  that,  instead  of  the  old 
method  of  treating  incised  wounds  by  keeping 
them  open  with  forcible  and  painful  applications, 
it  was  better  simply  to  place  the  parts  securely 
in  their  natural  situation,  and  then  to  let  them 
alone.  In  the  second  place,  we  may  do  much 
good  by  a  palliative  and  preventive  course,  by 
alleviating  pain,  procuring  sleep,  guarding  the 
diet,  regulating  the  alimentary  canal,  —  in  fine, 
by  obviating  such  sufferings  as  admit  of  mitiga- 
tion, and  preventing  or  removing  the  causes  of 
others,  which  are  incidental,  but  not  necessary, 
to  the  state  of  disease.  In  doing  this,  we  must 
distinguish  between  the  disease  itself,  and  the 
accidents  of  the  disease,  for  the  latter  often 
admit  of  relief,  when  the  former  does  not.  "We 
should  also  inquire  whether  the  original  cause 
of  the  disease,  or  any  .accessory  cause,  is  still 


48  SELF-LIMITED   DISEASES. 

operating,  and,  if  so,  whether  it  can  in  any  meas- 
ure be  prevented  or  removed ;  as,  for  example, 
when  it  exists  in  the  habits  of  life  of  the  patient, 
in  the  local  atmosphere,  or  in  the  presence  of 
any  other  deleterious  agent.  [Note  K.]  Lastly, 
by  a  just  prognosis,  founded  on  a  correct  view 
of  the  case,  we  may  sustain  the  patient  and  his 
friends  during  the  inevitable  course  of  the  dis- 
ease ;  and  may  save  them  from  the  pangs  of  dis- 
appointed hope  on  the  one  side,  or  of  unneces- 
sary despondency  on  the  other. 

It  will  be  seen  that,  in  the  foregoing  remarks, 
a  low  estimate  has  been  placed  on  the  resources 
of  art,  when  compared  with  those  of  nature. 
But  I  may  be  excused  for  doing  this  in  the  pres- 
ence of  an  audience  of  educated  men,  and  the 
members  of  a  society,  whose  motto  is  Natura 
duce.  The  longer  and  the  more  philosophically 
we  contemplate  this  subject,  the  more  obvious  it 
will  appear  that  the  physician  is  but  the  minis- 
ter and  servant  of  nature  ;  that,  in  cases  like 
those  which  have  been  engaging  our  considera- 
tion, we  can  do  little  more  than  follow  in  the 
train  of  disease,  and  endeavor  to  aid  nature  in 
her  salutary  intentions^  or  to  remove  obstacles 


SELF-LIMITED   DISEASES.  49 

out  of  her  path.  How  little,  indeed,  could  we 
accomplish  without  her  aid  !  It  has  been  wisely 
observed,  by  Sir  Gilbert  Blane,  that  "  the  benefit 
derivable  to  mankind  at  large,  from  artificial  rem- 
edies, is  so  limited,  that,  if  a  spontaneous  princi- 
ple of  restoration  had  not  existed,  the  human 
species  would  long  ago  have  been  extinct."  * 

The  importance  and  usefulness  of  the  medical 
profession,  instead  of  being  diminished,  will  al- 
ways be  elevated,  exactly  in  proportion  as  it 
understands  itself,  weighs  justly  its  own  powers, 
and  professes  simply  what  it  can  accomplish.  It 
is  no  derogation  from  the  importance  of  our  art, 
that  we  cannot  always  control  the  events  of  life 
and  death,  or  even  of  health  and  sickness.  The 
incompetency,  which  we  feel  in  this  respect,  is 
shared  by  almost  every  man  upon  whom  the 
great  responsibilities  of  society  are  devolved. 
The  statesman  cannot  control  the  destinies  of 
nations,  nor  the  military  commander  the  event 
of  battles.  The  most  eloquent  pleader  may  fail 
to  convince  the  judgment  of  his  hearers,  and  the 
most  skilful  pilot  may  not  be  able  to  weather  the 

*  Medical  Logic,  p.  49. 

5 


50  SELF-LDfTTED   DISEASES. 

storm.  Yet  it  is  not  the  less  necessary  that  re- 
sponsible men  should  study  deeply  and  under- 
standingly  the  science  of  their  respective  voca- 
tions. It  is  not  the  less  important,  for  the  sake 
of  those  whose  safety  is,  and  always  will  be,  com- 
mitted to  their  charge,  that  they  should  look  with 
unbiased  judgment  upon  the  necessary  results  of 
inevitable  causes.  And  while  an  earnest  and  in- 
quiring solicitude  should  always  be  kept  alive,  in 
regard  to  the  improvement  of  professional  knowl- 
edge, it  should  never  be  forgotten  that  knowl- 
edge has  for  its  only  just  and  lasting  foundation 
a  rigid,  impartial,  and  inflexible  requisition  of 
the  truth. 


NOTES.  51 


NOTES 


NOTE  A. 

THE  difficulty  of  discriminating  between  the  symptoms 
of  disease,  and  the  effects  of  treatment,  has  undoubtedly 
led  to  much  erroneous  practice,  so  that  we  cannot  be  too 
careful  or  vigilant,  in  watching  the  consequences  of  our 
own  remedies.  For  a  long  time  the  effects  resulting  from 
an  excessive  use  of  mercury  were  mistaken  for  the  phe- 
nomena of  syphilis.  The  arterial  reaction,  described  by 
Marshall  Hall,  which  sometimes  follows  excessive  blood- 
letting, has  been  confounded  with  the  arterial  action  of 
disease  requiring  further  depletion.  Constitutional  irrita- 
tion, produced  or  kept  up  by  an  inordinate  use  of  vesica- 
tories  and  other  counter-stimulants,  has  been  made  a 
reason  for  the  further  continuance  of  those  applications. 
Much  acute  and  unnecessary  suffering  has  been  caused  by 
the  prolonged  application  of  sinapisms  to  the  tender  skins 
of  infants,  and  the  limbs  of  dying  patients.  The  pains  of 
hunger,  resulting  from  a  too-restricted  diet,  are  most 
keenly  felt  by  convalescents  from  sickness ;  yet  we  some- 
times see  the  cries  of  infants,  arising  from  this  cause,  mis- 
taken for  signs  of  disease,  and  met  by  the  practitioner 
with  medicines,  and  further  restrictions.  I  do  not  speak 
of  these  things  as  common  occurrences,  yet  they  have  been 


52  SELF-LIMITED   DISEASES. 

sufficiently  so,  to  render  it  obvious  that  circumspection, 
on  the  part  of  the  practitioner,  is  necessary  to  avoid  them. 

NOTE  B. 

The  vaccine  vesicle  might,  if  it  were  desired,  be  extir- 
pated by  the  knife  or  caustic,  although,  if  the  vesicle  be 
sufficiently  developed  to  excite  notice,  the  surgical  remedy 
would  be  at  least  as  bad  as  the  disease.  In  regard  to 
medical  remedies,  I  have  had  occasion  to  observe  their 
inefficiency  in  cases  where  inflammatory  diseases,  requir- 
ing treatment,  have  occurred  during  the  progress  of  cow- 
pox.  The  depletive  remedies  employed  for  the  former 
diseases  did  not  affect  the  progress  of  the  vaccine  vesicle. 
When  this  vesicle  is  slow  and  diminutive,  it  is  commonly 
owing  to  the  coexistence  of  some  other  cutaneous  affec- 
tion. 

In  regard  to  mercurial  salivation,  although  the  treat- 
ment proposed  by  Dr.  Pearson  and  others  may  have  been 
reiterated  in  many  volumes,  yet  I  believe  that  most  prac- 
titioners of  experience  find  themselves  obliged  to  rely  upon 
time  and  palliatives,  aided  by  the  withdrawal  of  the  cause. 

NOTE  C. 

The  modern  introduction  of  the  non-mercurial  treat- 
ment in  syphilis  might  almost  lead  us  to  consider  this 
malady,  also,  as  among  the  self-limited  diseases.  Although 
syphilis,  as  it  existed  in  the  days  of  Mr.  Hunter,  appears 
to  have  yielded  to  mercury  alone,  so  that  this  eminent 
author  regarded  it  as  one  of  the  distinguishing  traits  of 
the  disease,  that  it  had  no  tendency  to  spontaneous  recov- 
ery j  yet  the  experience  of  the  last  twenty  years  has  shown 


NOTES.  53 

that  syphilis,  as  it  now  exists  in  all  its  prominent  varie- 
ties, has  been  cured,  in  many  thousands  of  cases,  by  a 
treatment  in  which  no  mercury  in  any  shape  is  employed. 
Nevertheless,  the  treatment  by  the  anti-phlogistic  method, 
which  has  been  substituted,  requires,  in  order  to  be  suc- 
cessful, more  or  less  depletion,  abstinence,  and  positive 
rest,  conjoined  occasionally  with  other  remedies.  So  that 
the  disease  still  undergoes  efficient  treatment ;  and,  indeed, 
when  it  is  wholly  neglected,  as  it  sometimes  is  by  the 
abject  and  the  reckless,  it  results  in  the  most  deplorable 
consequences,  of  which  our  hospitals  and  almshouses  fur- 
nish sufficient  and  frequent  examples. 

NOTE  D. 

Corvisart  died  of  a  disease  of  the  heart ;  Laennec  and 
Armstrong  of  pulmonary  consumption.  Other  examples 
may  be  found  of  persons  who  were  writers  on  the  diseases 
of  which  they  afterwards  died. 

NOTE  E. 

Ulceration  in  the  tonsils  and  palate  is  the  most  common 
lesion  in  scarlatina,  but  the  other  morbid  appearances  dis- 
covered in  autopsies  of  cases  of  this  disease  are  exceed- 
ingly various  and  uncertain.  Among  those  which  I  have 
observed,  or  which  have  been  noticed  by  my  medical 
friends  in  this  city,  are  ulcerations  in  the  larynx,  and 
inflammation  of  the  mucous  membrane  of  the  trachea  and 
bronchiae.  In  one  case  of  thirty-six  hours'  duration,  the 
chief  morbid  appearance,  in  addition  to  the  ulcerated 
throat,  was  an  extensive  peritonitis  with  effusion  of  coag- 
ulating lymph  lining  most  of  the  abdominal  cavity. 


,54  SELF-LIMITED   DISEASES. 

Serous  effusions  in  and  upon  the  brain  have  been  occa- 
sionally noticed,  but  most  frequently  in  the  secondary 
forms  of  the  disease.  In  the  child  of  an  eminent  physi- 
cian in  this  city,  whose  case  and  autopsy  I  witnessed, 
there  was  slight  ulceration  of  the  tonsils,  but  no  lesion  of 
any  important  viscus  could  be  detected,  though  diligently 
sought  for  by  our  best  pathological  anatomists.  Two  sim- 
ilar cases  have  been  stated  to  me,  and  I  find  them  also 
noticed  by  some  writers  on  the  disease.  In  these  cases 
the  poison  of  the  disease  seems  to  destroy  life,  without 
exciting  inflammatory  action. 

Family  predisposition  appears  to  influence  the  tendency 
to  mortality  in  scarlatina.  In  some  cases  the  children  of 
a  family  all  die  in  rapid  succession.  A  predisposition  to 
take  the  disease  seems  also  affected  by  the  same  cause, 
so  that  it  sometimes  operates  during  the  same  season  upon 
members  of  the  same  family  residing  in  different  places, 
without  personal  intercourse. 

The  latent  period  between  the  inception  and  develop- 
ment of  this  disease  appears  subject  to  great  variation. 
I  knew  a  patient  to  be  taken  with  scarlet  fever  in  forty- 
eight  hours  after  arriving  in  this  country  by  a  passage  of 
forty  days  from  Europe.  In  this  instance,  as  no  case 
existed  in  the  ship,  the  latent  period  must  have  been  less 
than  two  days,  or  more  than  forty. 

Scarlatina  and  some  other  eruptive  fevers  reciprocally 
affect  the  development  of  each  other.  During  the  preva- 
lence of  measles  and  scarlet  fever  in  this  city,  in  the  win- 
ter and  spring  of  1832,  a  considerable  number  of  cases 
occurred,  in  which  the  two  diseases,  each  preserving  its 
own  distinctive  character,  were  successively  passed  through 


NOTES.  55 

by  patients,  without  quitting  their  beds,  yet  the  diseases 
were  in  no  wise  blended,  or  intermixed.  In  the  family  of 
a  lady  residing  in  Tremont  Place,  five  individuals  had 
scarlet  fever,  and  three  of  them  measles,  nearly  at  the 
same  time.  The  circumstances  are  interesting.  One 
child  had  measles  first,  the  disappearance  of  which  was 
immediately  followed  by  scarlatina  ;  both  diseases  proved 
mild,  and  were  completed  in  about  twenty  days.  Another 
child  had  severe  scarlatina  with  a  bad  throat,  the  ulcers 
of  which  were  not  healed  before  the  sixteenth  day.  After 
this  the  patient  remained  stationary,  with  a  quick  pulse, 
and  without  return  of  appetite  or  strength,  for  several  days 
more,  when  the  eruption  of  measles  appeared  under  the 
cuticle  which  was  desquamating  from  scarlatina,  and 
passed  through  its  regular  course.  A  third  child  in  the 
same  family  was  affected  in  a  more  singular  manner. 
The  eruption  of  measles  appeared  first,  with  slight  catarrh- 
al  symptoms,  and  continued  one  day.  It  then  vanished, 
and  was  in  two  days  succeeded  by  scarlet  fever.  This 
lasted  about  a  week,  and  when  the  patient  was  expected 
to  get  well,  the  crimson  eruption  of  measles  reappeared, 
and  lasted  three  days  more.  In  these  cases  the  two  dis- 
eases, though  probably  coexisting  in  the  body  at  the  same 
time,  and  in  the  last  case  decidedly  so,  were  never  extant 
at  once  in  an  active  or  characteristic  form.  There  was 
no  reason  to  suppose  that  the  intensity  of  either  disease 
was  diminished,  or  aggravated,  by  the  presence  of  the 
other. 

Scarlet  fever  exists  in  some  cases  where  its  presence  is 
not  suspected,  as  the  following  cases,  selected  from  a  num- 
ber of  similar  ones,  may  show.  A  child,  previously  well, 


56  SELF-LIMITED   DISEASES. 

was  taken  in  fits  at  night,  and  died  on  the  following  morn- 
ing. As  the  disease  was  not  epidemic  at  the  time,  the 
nature  of  the  complaint  was  not  suspected  till  a  few  hours 
before  death,  when  another  child  coming  out  with  the 
eruption,  this  circumstance  led  me  to  an  examination  of 
the  throat  of  the  first,  which  was  found  ulcerated.  In 
another  case,  a  child  was  affected  with  a  very  troublesome 
rheumatic  stiff"  neck.  On  inquiry,  it  was  ascertained  that 
a  scarlet  efflorescence  had  existed  on  the  preceding  week, 
of  which  the  rheumatism  was  doubtless  a  sequel,  though 
the  nature  of  the  eruption  had  not  been  apprehended. 

The  sequelae  or  secondary  effects  of  scarlet  fever  are 
extremely  various.  Rheumatic  affections  are  among  the 
most  common.  Dropsical  effusions  are  frequent,  both  in 
the  cellular  texture  and  in  large  cavities.  Anasarca  and 
ascites  are  not  of  uncommon  occurrence.  I  have  seen 
hydrocele,  which  disappeared  spontaneously  in  a  few  weeks, 
and  hydrocephalus,  which  proved  fatal.  Troublesome  indu- 
rations of  the  parotid  and  submaxillary  glands  often  occur, 
and  may,  or  may  not,  be  followed  by  suppuration.  A 
fatal  induration  of  the  whole  anterior  neck  is  sometimes 
met  with.  This  I  have  seen  both  in  the  primary  and  sec- 
ondary disease.  A  purulent  or  sanious  discharge  from  the 
ears  occasionally  follows  scarlet  fever,  and  sometimes  con- 
tinues long  enough  to  destroy  the  organic  texture,  and 
with  it  the  sense  of  hearing,  in  one  or  both  ears.  Erysip- 
elas and  roseola  are  among  the  other  appearances  which  I 
have  seen  to  supervene  upon  this  uncertain  disease.  For- 
tunately, however,  the  largest  portion  of  cases  are  attended 
with  no  sequelas,  or  with  such  as  disappear  spontaneously 


NOTES.  57 

in  their   own   time,   without    permanent  injury   to   the 
patient. 

NOTE  F. 

We  have  sufficient  evidence  that  many  cases  of  gout, 
both  in  this  country  and  Europe,  have  had  their  paroxysms 
abridged  by.  the  use  of  colchicum,  and  different  species  of 
veratrum.  Some  individuals  are  fortunate  enough  to 
obtain  this  effect  under  a  moderate  dose,  which  only  affects 
the  bowels.  But  in  most  persons  it  is  necessary  to  take 
enough  of  the  medicine  to  produce  vomiting  and  tempo- 
rary prostration,  before  the  desired  result  can  be  obtained. 
This  effect  is  sometimes  so  severe  that  many  patients  pre- 
fer the  disease  to  the  remedy,  and  in  fact  the  practice  is 
hardly  warranted  in  the  case  of  very  feeble  or  aged  per- 
sons. 

Three  cases  have  occurred  to  me,  in  which  gout  has  dis- 
appeared altogether  under  an  entire  abstinence  from  spirit- 
uous and  fermented  liquids.  In  one  of  these  it  is  now 
thirteen  years  since  a  paroxysm  occurred,  and  in  another 
seven  years,  the  individuals  both  enjoying  good  health,  and 
leading  active  lives.  The  third  case  was  that  of  a  gentle- 
man of  this  city,  lately  deceased  at  seventy-six  years  of 
age,  who  had  suffered  more  than  twenty  years  with  gout, 
and  was  reduced  to  use  crutches.  After  commencing  a 
course  of  entire  abstinence,  the  paroxysms  began  to  abate 
in  violence,  and  for  the  last  seven  years  of  his  life  he 
assured  me  he  had  not  felt  the  sensation  of  gout.  In  his 
last  illness  a  slight  chiragra  occurred  after  taking  a  dose 
of  tincture  of  rhubarb.  Some  other  cases  are  now  in  the 
progress  of  trial,  with  apparent  alleviation  of  the  disease. 


58  SELF-LIMITED   DISEASES. 

I  have  been  told  by  others  that  this  plan  of  treatment  has 
in  some  instances  failed  to  be  followed  by  relief,  and  very 
probably  this  may  be  true ;  but  such  instances  have  not 
yet  come  under  my  personal  observation,  where  the  exper- 
iment has  been  fairly  made  in  the  acute  disease. 

NOTE  G-. 

The  natural  history  of  the  small  ascarides  is  curious, 
and  not  well  understood.  Many  individuals  are  infested 
with  them  in  childhood,  but  get  rid  of  them  as  they  ad- 
vance in  years.  Some,  however,  are  troubled  with  them 
during  the  whole  of  a  long  life,  though  they  are  repre- 
sented as  less  annoying  after  middle  age  than  before. 
They  most  commonly  appear  periodically,  both  in  children 
and  adults,  after  intervals  of  from  three  to  six  weeks. 
During  the  intervals  they  are  neither  felt  nor  seen  in  the 
discharges.  Their  periodical  return  is  announced  by  a 
sense  of  itching  and  burning  at  the  extremity  of  the  rec- 
tum, felt  principally  in  the  evening,  sometimes  producing 
tumefaction,  and  eruption  of  the  neighboring  skin.  This 
irritation  continues  to  recur  every  evening  for  perhaps  a 
week,  or  more,  and  then  ceases.  During  this  time  the 
worms  are  discharged  alive  and  active  in  every  alvine 
evacuation.  Cathartics  and  enemata  bring  away  vast 
numbers  of  them,  but  without  diminishing  the  annoyance 
occasioned  by  those  which  remain  behind.  At  length 
they  spontaneously  cease  to  appear,  the  irritation  subsides, 
cathartics  no  longer  bring  them  to  light,  and  the  inexpe- 
rienced practitioner  flatters  himself  that  the  evil  is  rem- 
edied. Nevertheless,  after  a  few  weeks,  they  again  return 
in  undiminished  numbers,  attended  by  the  same  phenomena 


NOTES.  59 

as  before.  "Whether  the  new  race  are  cotemporaries  of 
the  old,  or  descendants  from  them,  it  is  not  easy  to  tell ; 
but  the  latter  supposition  seems  most  probable. 

It  is  commonly  believed  that  the  principal  residence  of 
ascarides  is  in  the  rectum,  because  they  are  most  felt  there. 
They  have  been  found,  however,  in  other  parts  of  the  ali- 
mentary tube.  Many  patients,  immediately  after  a  cessa- 
tion of  the  annoyance  in  the  rectum,  are  visited  by  pain 
in  the  epigastrium,  attended  with  costiveness  and  clay- 
colored  discharges.  This  state  continues  for  two  or  three 
days,  and  is  then  followed  by  a  bilious  diarrhoaa.  I  have 
repeatedly  known  these  consecutive  events  to  occur  with 
great  regularity  for  half  a  dozen  years,  so  much  so  that 
my  inquiries  are  generally  directed  towards  this  cause, 
when  children  have  complained  of  epigastric  pains  at  reg- 
ular periods..  Whether,  in  these  cases,  the  worms  ascend 
to  the  duodenum  and  mouth  of  the  biliary  duct,  or  whether 
the  whole  is  an  affair  of  sympathy,  future  autopsies  may 
perhaps  determine. 

The  nidus  of  these  animals,  and  perhaps  the  food  also, 
appears  to  be  the  mucus  which  lines  the  alimentary  canal. 
Buried  in  this  substance,  they  resist  the  effect  of  the  most 
violent  cathartics  and  vermifuges,  oil  of  turpentine  and 
croton  not  excepted.  If  it  be  permitted  to  derive  an 
hypothesis  from  the  phenomena  which  they  exhibit,  it 
would  be,  that  during  a  greater  part  of  the  time  they 
remain  quietly  embedded  in  this  mucus,  deriving  from  it 
their  habitation  and  nourishment,  being  at  the  same  time 
secured  from  the  effects  of  the  peristaltic  motion  by  this 
and  by  the  adhesive  power  of  suction ;  but  that  at  certain 
periods,  perhaps  at  their  generating  seasons,  they  issue 


60  SELF-LIMITED   DISEASES. 

forth  from  this  covert,  and  mingle  themselves  in  the  con- 
tents of  the  alimentary  canal ;  in  consequence  of  which 
they  are  liable  to  be  expelled  with  the  common  mass. 

I  have  known  ascarides  to  be  eradicated  by  a  severe 
dysentery.  In  some  cases  they  have  been  totally  removed 
by  large  injections  of  oil,  particularly  of  lamp  oil.  But 
more  frequently  they  resist  these  and  most  other  remedies 
for  a  series  of  years.  A  temporary  palliative  may  always 
be  found  in  small  injections  of  weak  salt  water,  or  even  of 
an  ounce  or  two  of  cold  water. 

NOTE  H. 

I  would  by  no  means  undervalue  the  exertions  which 
have  been  made,  and  are  still  making,  by  indefatigable  and 
distinguished  men,  for  the  control  of  what  are  called  pes- 
tilential epidemics.  I  would  only  be  understood  to  state 
that  no  one  method  of  treatment,  in  the  diseases  enumer- 
ated, appears  to  have  acquired  sufficient  credit  with  the 
profession  generally,  to  be  turned  in  their  hands  to  any 
great  practical  account.  The  records  of  medical  litera- 
ture show  that  a  period  of  ten  years  has  seldom  elapsed 
without  the  annunciation  of  some  effectual  mode  of  prac- 
tice, in  some  one  of  these  diseases.  And,  what  is  more,  the 
amount  of  evidence  with  which  these  statements  are  sup- 
ported, and  the  pathological  skill  with  which  the  indica- 
tions are  explained,  seem  sometimes  sufficient  to  shake  the 
incredulity  of  the  most  sceptical.  Nevertheless,  after  a 
certain  term  of  years,  the  diseases  are  found  to  be  fatal  as 
before,  and  fresh  innovations  in  practice  take  the  place  of 
the  old,  and  excite  confidence  anew  among  the  sanguine 
and  ardent  members  of  the  profession.  T'no  truth  i?,  that 


NOTES.  61 

no  epidemic  is  equally  malignant  in  all  seasons  and  places ; 
and,  from  some  unknown  cause,  the  laws  which  affect  its 
tendency  to  death  or  recovery  are  essentially  different  in 
different  climates  at  the  same  period,  or  in  the  same  cli- 
mate at  different  periods.  This  fact  must  be  known  to 
those  who  have  personal  experience  in  regard  to  these  dis- 
eases, or  who  are  conversant  in  their  epidemic  history. 
Reliance,  therefore,  cannot  be  justly  accorded  to  any  mode 
of  treatment  which  has  not  had  the  testimony  of  a  large 
number  of  years  in  its  favor,  and  this  also  under  a  proper 
variety  of  situations  and  circumstances.  Were  it  other- 
wise, these  diseases,  in  the  hands  of  the  medical  profes- 
sion, would  long  ago  have  ceased  to  be  pestilences. 

NOTE  I. 

I  am  aware  that  some  of  the  most  distinguished  French 
pathologists  of  the  present  day  incline  to  the  opinion  that 
many  acute  diseases,  or  at  least  inflammations,  are  incapa- 
ble of  being  shortened  in  their  duration,  by  art.  [See 
marginal  note,  page  30.]  The  opposite  opinion  prevails 
very  generally  in  this  country  and  in  England,  and  it 
would  be  premature  to  consider  the  question  as  decided, 
until  it  has  been  submitted  more  extensively  to  the  test  of 
comparative  numerical  results.  It  is  certain  that  the 
most  distressing  symptoms  of  acute  inflammations  are  often 
arrested  at  once  by  remedies.  This  happens,  for  example, 
from  blood-letting  in  croup  and  pleurisy,  and  from  opium 
in  strangury  and  dysentery.  If,  however,  the  disease  is 
fully  established  before  the  application  of  remedies,  it 
usually  goes  on  to  complete  its  course,  and  in  that  case 
the  remedies  are  palliatives  only.  And  if  remedies  be 
6 


62  SELF-LIMITED   DISEASES. 

applied  in  the  incipient  stage,  an  uncertainty  hangs  over 
our  diagnosis,  for  the  supposed  pleurisy  may  have  been 
rheumatism,  and  the  supposed  croup  may  have  been 
catarrh,  or  laryngismus";  for  even  the  physical  signs 
require  a  certain  maturity  of  development  in  disease  to 
render  them  satisfactory.  Leaving,  then,  as  undecided, 
the  question  of  positive  duration  in  acute  inflammations, 
we  do  not  risk  much  in  asserting  that  their  character  is 
often  essentially  modified  by  treatment,  so  that  they  are 
more  easily  supported  by  the  patient,  and  the  apparent 
danger  attending  them  diminished.  We  must  wait  for 
the  modern  spirit  of  accurate  inquiry  to  furnish  a  further 
light  on  this  subject. 

NOTE  K. 

As  examples,  it  may  be  stated  that  the  salivation  pro- 
duced by  mercury  gets  well  of  itself,  provided  the  original 
cause  is  discontinued.  An  issue  made  by  caustic,  or  other- 
wise, gets  well  after  the  original  cause  has  ceased  to  ope- 
rate; but  if  an  accessory  cause  is  present,  such  as  the 
pressure  of  an  irritating  foreign  substance,  it  then  fails  to 
heal.  The  local  atmosphere  may  be  considered  as  an 
original,  or  an  accessory  cause,  in  those  diseases  which 
are  benefited  by  change  of  climate  or  situation.  A  long 
train  of  diseases  might  be  mentioned,  which  are  brought 
on,  or  kept  up,  by  injurious  habits  of  life,  and  are  relieved 
or  cured,  not  by  medicines,  but  by  a  removal  of  the  habit 
under  which  they  have  been,  or  continue  to  be,  induced. 
Such  are  the  diseases  which  attend  on  sedentary  life, 
intemperate  indulgences,  lactation,  insalubrity  of  diet,  &c. 


NOTES.  63 

Sometimes  a  disease,  the  cause  of  which,  is  not  removed, 
may  disappear  in  consequence  of  a  new  habit,  by  which 
the  system  becomes  capable  of  bearing  with  impunity  the 
influence  of  this  cause ;  as  in  sea-sickness. 


ON     THE 

TREATMENT   OF   DISEASE! 

AN     INTRODUCTORY    LECTURE,     DELIVERED    BEFORE     THE     MEDICAL 

CLASS     AT   THE   MASSACHUSETTS    MEDICAL  COLLEGE    IS 

BOSTON,    NOVEMBER    3,    1852. 


OP  the  sciences  which  have  most  occupied  the 
time  and  labor  of  mankind,  a  certain  number  lead 
by  their  investigations  to  clear  and  positive  re- 
sults, and  enlarge  the  amount  of  human  knowl- 
edge by  the  discovery  and  promulgation  of  abso- 
lute truth.  Another  portion  lead  only  to  results 
which  are  probable  or  presumptive  in  their  char- 
acter, and  which  furnish  to  mankind  rules  of 
action,  in  cases  where  better  lights  cannot  be 
obtained.  To  the  former  class  has  been  given 
the  name  of  exact  sciences,  and  to  the  latter  the 
name  of  presumptive  or  conjectural  sciences. 
Mathematics  form  an  exact  science,  on  the  con- 
clusions of  which,  when  once  known,  there  can 


TREATMENT   OF  DISEASE.  65 

be  no  difference  of  opinion.  In  like  manner, 
chemistry  and  mechanics,  astronomy  and  por- 
tions of  natural  history,  are  examples  of  exact 
sciences,  the  demonstrations  of  which,  when  once 
made  clear,  may  afterwards  be  modified  and  en- 
larged, but  are  never  fundamentally  shaken.  On 
the  other  hand,  the  important  sciences  of  ethics 
and  politics,  of  commerce  and  finance,  of  govern- 
ment, and  speculative  theology,  are  inexact  in 
many  of  their  principles,  as  is  proved  by  the 
widely  different  constructions  under  which  men 
receive  and  apply  them  to  practice. 

It  would  at  first  seem  that  the  exact  sciences 
were  those  most  worthy  the  cultivation  of  intel- 
ligent minds,  inasmuch  as  they  lead  to  satisfac- 
tory, and  therefore  to  gratifying,  results ;  and 
because,  in  their  more  elevated  departments, 
they  involve  and  require  some  of  the  highest 
reaches  of  the  human  intellect.  But  in  the  opin- 
ions of  mankind,  as  evinced  by  their  practice, 
the  opposite  judgment  prevails,  and  probably 
nine  tenths  of  the  labor  of  educated  and  intel- 
lectual men  are  employed  on  studies  which  are, 
in  their  nature,  uncertain  and  conjectural. 

The  cause  of  this  great  ascendency  in  the 
6* 


66  TKEATMENT   OF  DISEASE. 

attention  given  to  the  inexact  sciences,  is  to  be 
found  in  the  vast  and  paramount  importance  of 
their  subjects,  and  also  in  the  difficulty  of  con- 
summating their  great  ends.  It  is  much  more 
important  to  mankind  to  know  how  to  avoid 
anarchy  and  crime,  -war,  famine,  poverty  and  pes- 
tilence, than  it  is  to  know  that  the  planet  Saturn 
has  a  ring,  or  that  a  lily  has  six  stamens,  that 
light  can  be  polarized,  or  that  potass  can  be 
decomposed.  Yet,  while  the  latter  propositions 
are  susceptible  of  absolute  demonstration,  the 
former  processes,  which  bear  directly  on  human 
happiness  or  misery,  are  frequently  removed 
beyond  our  foresight  or  control.  The  wisest 
men  often  fail  to  influence  the  destinies  of  states, 
families,  and  individuals,  and  the  shrewdest  cal- 
culators are  baffled  in  regard  to  a  coming  crop,  a 
pecuniary  crisis,  a  glut  in  the  commercial  mar- 
ket, or  a  change  in  the  public  morals.  Never- 
theless, the  wise  man,  conscious  of  superior  tal- 
ent, and  the  philanthropist,  desirous  of  the  public 
weal,  and  even  the  interested  man,  who  looks  to 
his  personal  advantage  and  progress,  must  give 
themselves  and  their  energies  to  studies  which 
involve  the  immediate  wants  of  their  fellow-men, 


TKEATMENT   OF   DISEASE.  67 

even  though  their  best  directed  efforts  should 
fail  of  the  desired  results.  And  the  simple  rea- 
son is,  that,  if  the  best  qualified  minds  decline  to 
undertake  this  task,  it  will  most  assuredly  be 
assumed  by  the  ignorant  and  presumptuous. 

Preeminent  among  the  inexact  and  speculative 
sciences  stands  practical  medicine,  a  science  older 
than  civilization,  cultivated  and  honored  in  all 
ages,  powerful  for  good  or  for  evil,  progressive 
in  its  character,  but  still  unsettled  in  its  princi- 
ples ;  remunerative  in  fame  and  fortune  to  its 
successful  cultivators,  and  rich  in  the  fruits  of  a 
good  conscience  to  its  honest  votaries.  Encum- 
bered as  it  is  with  difficulty,  fallacy  and  doubt, 
medicine  yet  constitutes  one  of  the  most  attract- 
ive of  the  learned  professions.  It  is  largely 
represented  in  every  city,  village  and  hamlet. 
Its  imperfections  are  lost  sight  of  in  the  over- 
whelming importance  of  its  objects.  The  living 
look  to  it  for  succor ;  the  dying  call  on  it  for 
rescue. 

The  greatest  boons  and  the  most  important 
objects  presented  to  our  aspirations  in  this  life, 
are  not  to  be  approached  through  paths  which 
are  straight  and  unmistakable.  The  avenues  to 


68  TREATMENT    OF   DISEASE. 

most  of  them  are  shadowed  by  doubts  or  clogged 
with  incessant  obstacles.  Next  to  the  spiritual 
welfare  of  men,  the  preservation  of  their  lives, 
the  peace  and  safety  of  their  communities,  the 
acquirement  and  preservation  of  their  worldly 
goods  are  among  the  objects  which  take  strong- 
est hold  on  their  desires.  Yet  grave  doubts  are 
justifiable,  whether  any  precise  means  have  yet 
been  agreed  upon  by  which  these  desirable  ends 
can  with  certainty  be  attained.  And  if  any  one 
deems  it  a  reproach  on  medicine  that  its  culti- 
vators have  not  arrived  at  a  common  faith  and 
practice,  let  him  consider  whether  the  laborers 
in  other  fields,  however  honest  their  intentions, 
are  agreed  in  their  theological  creeds  and  politi- 
cal platforms. 

Considering  the  great  importance  of  the  ob- 
jects of  medicine,  the  frequent  and  earnest  ap- 
peals made  for  its  assistance,  and  the  vast  sums 
annually  expended  in  its  remuneration,  it  is  not 
surprising  that  disappointment  and  complaint 
often  follow  the  failures,  necessary  or  unneces- 
sary, of  medical  practice.  "  Man  is  of  few  days 
and  full  of  trouble."  Yet,  in  the  face  of  this 
acknowledged  truth,  he  requests  and  expects 


TREATMENT   OF  DISEASE.  69 

that  his  physician  will  provide  him  with  many 
days,  and  remove  at  least  his  bodily  troubles. 
This  expectation  on  his  part  is  reasonable  or 
otherwise,  according  to  the  circumstances  under 
which  it  is  made.  It  is  unreasonable,  if  his  case 
is  helpless,  and  he  is  merely  paying  the  debt  of 
suffering  and  death  which  his  mortal  nature 
exacts.  But  it  is  reasonable  and  proper,  if  his 
complaint  is  of  a  curable  kind,  or  if,  whether 
curable  or  not,  his  physician  has  claimed  and 
vaunted  the  power  to  remove  it. 

Most  men  form  an  exaggerated  estimate  of  the 
powers  of  medicine,  founded  on  the  common  ac- 
ceptation of  the  name,  that  medicine  is  the  art 
of  curing  diseases.  That  this  is  a  false  defini- 
tion, is  evident  from  the  fact  that  many  diseases 
are  incurable,  and  that  one  such  disease  must  at 
last  happen  to  every  living  man.  A  far  more 
just  definition  would  be,  that  medicine  is  the  art 
of  understanding  diseases,  and  of  curing  or  re- 
lieving them  when  possible.  Under  this  accep- 
tation our  science  would,  at  least,  be  exonerated 
from  reproach,  and  would  stand  on  a  basis  capa- 
ble of  supporting  a  reasonable  and  durable  system 
for  the  amelioration  of  human  maladies. 


70  TREATMENT   OF   DISEASE. 

Every  young  man,  who  proposes  to  become  a 
member  of  the  medical  profession,  should  ask 
himself  whether  he  considers  medicine  a  liberal 
and  honorable  science,  to  be  followed  for  the 
good  it  may  do  to  mankind,  or  as  a  dishonest 
trade,  to  be  pursued  for  the  purpose  of  profiting 
himself  by  the  deception  of  his  fellow-men.  If 
he  accepts  his  profession  in  the  first  sense,  he 
will  strive  to  understand  his  science  in  ah1  its 
bearings,  and  practise  it  with  conscience  and 
fidelity ;  if  in  the  latter,  he  will  put  his  con- 
science aside,  and  study  only  the  low  arts  which 
entrap  the  credulous  and  unwary. 

With  the  trade  of  medicine  I  have  nothing  to 
do.  Knowing  that  I  address  an  ingenuous  and 
cultivated  audience,  composed  mainly  of  young 
men  who  are  looking  forward  to  an  honest  and 
honorable  place  in  professional  life,  I  make  no 
apology  for  proceeding  to  express  my  belief  of 
the  manner  in  which  medicine  should  be  prac- 
tised and  disease  treated,  for  the  reciprocal  ben- 
efit of  him  who  gives,  and  of  him  who  receives 
its  aids. 

Let  no  one  deceive  himself  by  believing  that 
success,  stable,  permanent,  honorable  success, 


TKEATMENT   OF   DISEASE.  71 

can  be  attained  without  knowledge  of  the  great 
principles  of  the  profession  and  science  of  med- 
icine. This  knowledge  must  consist  in  an  accu- 
rate acquaintance  with  the  structure  and  offices 
of  the  human  body,  and  the  laws  of  its  healthy 
condition.  After  these  follows  the  science  of 
pathology,  involving  the  great  and  fundamental 
art  of  diagnosis,  by  which  the  diseases  of  the 
human  body  are  detected,  and  distinguished 
rightly  from  each  other.  The  power  of  distin- 
guishing diseases  lies  at  the  root  of  ah1  correct 
and  enlightened  practice,  and  without  it  ah1  med- 
ical action  is  empirical  and  fortuitous.  There  is 
no  more  pernicious  error  than  for  a  physician  to 
believe  that  he  can  prescribe  safely  for  the  symp- 
toms of  a  sick  man,  without  understanding,  in 
some  measure,  the  nature  of  his  disease.  Symp- 
toms are  of  various  import,  according  to  the  seat 
of  their  origin  and  the  nature  of  their  causes  ; 
and  if  taken  alone  without  a  correct  interpreta- 
tion of  these  attendant  considerations,  they  often 
lead  to  a  wrong  result,  or  to  no  result  at  all.  A 
patient  not  unfrequently  sends  for  a  physician 
on  account  of  a  certain  symptom  which  is  dis- 
tressing him,  and  which  may  be,  for  example,  a 


72  TEEATMENT   OF  DISEASE. 

pain  in  the  abdomen,  or  in  the  head.  Now,  a 
pain  in  the  abdomen  may  arise  from  colic  or  per- 
itonitis, from  rheumatism  or  neuralgia,  from  dys- 
entery, from  calculus,  carcinoma  or  strangulation. 
And,  in  like  manner,  a  pain  in  the  head  may  arise 
from  a  multitude  of  different  and  even  opposite 
causes.  Now  it  is  well  known  that  the  kind  of 
treatment  which  is  effectual  in  one  case,  is  perni- 
cious in  another ;  and  he  who  prescribes  for  the 
symptom  irrespectively  of  the  cause,  is  quite  as 
likely  to  do  mischief  to  his  patient  as  good,  and 
quite  as  likely  to  destroy  life  as  to  save  it. 

If  the  question  be  asked,  what  makes  a  great 
physician,  and  one  who  is  appealed  to  by  his 
peers,  and  by  the  discerning  portion  of  the  pub- 
lic, for  counsel  in  difficult  cases,  I  would  answer, 
that  he  is  a  great  physician  tvho,  above  other  men, 
understands  diagnosis.  It  is  not  he  who  prom 
ises  to  cure  all  maladies,  who  has  a  remedy  ready 
for  every  symptom,  or  one  remedy  for  all  symp- 
toms ;  who  boasts  that  success  never  fails  him, 
when  his  daily  history  gives  the  lie  to  such  as- 
sertion. It  is  rather  he,  who,  with  just  discrimi- 
nation, looks  at  a  case  in  all  its  difficulties ;  who, 
to  habits  of  correct  reasoning,  adds  the  acquire- 


TREATMENT   OP   DISEASE.  73 

ments  obtained  from  study  and  observation ;  who 

« 

is  trustworthy  in  common  things  for  his  common 
sense,  and  in  professional  things  for  his  judg- 
ment, learning  and  experience  ;  who  forms  his 
opinion  positive  or  approximative,  according  to 
the  evidence  ;  who  looks  at  the  necessary  results 
of  inevitable  causes ;  who  promptly  does  what 
man  may  do  of  good,  and  carefully  avoids  what 
he  may  do  of  evil.  Examples  are  rare  of  this 
perfection,  yet,  for  an  approach  to  such  a  stand- 
ard of  professional  excellence,  I  would  venture 
to  direct  your  remembrance  to  the  venerable 
ex-professor,  fortunately  yet  among  us,  of  the 
theory  and  practice  in  this  University. 

Every  citizen,  whose  capacity  is  able  to  reach 
the  ordinary  affairs  of  life,  is  aware  that  the  per- 
sons most  capable  of  discharging  the  common 
offices,  or  of  exercising  the  common  arts  and 
duties  of  life,  are  the  individuals  who  have,  by 
talents,  education  and  practice,  become  EXPERTS 
in  those  arts  and  duties ; — and  that,  on  the  other 
hand,  those  persons  who  profess  to  have  acquired 
knowledge  by  intuition,  to  have  become  learned 
without  labor,  and  to  have  arrived  by  short  cuts 
at  results  and  qualifications  which  demand  years 
7 


74  TREATMENT   OP   DISEASE. 

of  preparatory  training,  must  be  incompetent 
and  treacherous  sources  of  reliance.  And  it  is 
the  general  admission  of  this  truth  which  gives 
support  and  confidence  to  the  various  profes- 
sions, arts  and  callings,  to  which  men  devote 
their  lives. 

A  little  machine  called  a  watch  is  carried  about 
by  most  persons,  and  when  this  machine  has 
stopped  or  is  out  of  order,  they  do  not  lay  their 
own  ignorant  hands  upon  it,  but  submit  the  case 
to  the  skill  of  an  expert,  who  is  known  to  be  qual- 
ified to  judge  and  act  in  such  cases.  It  is  the 
duty  of  this  artist,  when  applied  to,  to  examine 
the  interior  of  the  watch,  to  ascertain,  by  the  use 
of  his  skill,  in  what  part  the  disease  is  situated, 
and  to  apply  to  that  part  the  appropriate  remedy. 
If  a  spring  or  a  chain  is  broken,  it  must  be  re- 
stored ;  if  the  wheels  are  out  of  gear,  they  must 
be  put  in  place  ;  if  the  hands  only  have  caught, 
they  have  only  to  be  liberated,  and  if  the  pivots 
are  dry  and  rough,  they  must  be  oiled  or  cleaned; 
—  and,  lastly,  if  the  watch  has  had  a  destructive 
fall,  if  it  has  been  crushed  by  being  trodden  on, 
if  it  has  lain  a  month  in  the  salt  water,  or  if  it 
is  worn  out  by  running  steadily  for  threescore 


TREATMENT   OF  DISEASE.  75 

years  and  ten,  then  the  case  is  incurable,  and  the 
only  palliative  advice  which  the  practitioner  can 
render  is,  that  the  owner  should  procure  a  new 
watch,  or  reconcile  himself  to  do  without  one. 

But  suppose  there  resides  in  the  place  a  watch- 
doctor  who  prescribes  for  symptoms,  and  who, 
among  other  things,  has  a  remedy  for  the  symp- 
tom of  stopping,  and  that  this  remedy  consists  in 
a  certain  kind  of  friction,  shaking,  or  manipula- 
tion, an  ointment  applied  to  the  outside,  or  an 
invisible  particle  of  some  nugatory  substance 
inserted  into  the  inside  ;  and  suppose  that  one 
or  two  watches  in  a  hundred  which  had  stopped 
by  accident,  should  by  accident  resume  their 
motions  under  such  treatment,  could  anything 
but  the  most  unmitigated  folly  draw  the  infer- 
ence that  such  a  person  is  entitled  to  become 
the  accredited  horologer  to  the  community  ? 

What  is  so  conspicuously  true  in  the  common 
business  of  life,  is  only  an  example  of  what  is 
more  vitally  true  in  the  practice  of  medicine. 
If  a  man  has  had  the  misfortune  to  get  a  shot  or 
a  stab  in  his  body,  he  does  not  need  a  doctor 
who  administers  a  specific  dose  or  a  sovereign 
plaster  for  holes  in  the  body ;  he  wants  a  man 


76  TREATMENT   OF  DISEASE. 

who  can  tell  him  whether  the  wound  has  passed 
inside  or  outside  of  his  peritoneum,  and  whether 
it  is  requisite  for  him  to  make  his  will,  or  to 
make  arrangements  for  pursuing  his  journey. 

But  the  prescribing  for  symptoms  in  the  dark 
is  not  the  only  instance  in  which  false  logic  has 
entered  into  medical  reasoning.  It  is  not  less 
absurd  to  suppose  that  disconnected  events, 
which  have  closely  followed  each  other,  have 
therefore  a  necessary  dependence  upon  each 
other.  Shrewd,  practical  men  do  not  thus 
govern  themselves  in  the  common  affairs  of  life. 
A  merchant,  about  to  send  a  ship  to  sea,  endeav- 
ors to  find  a  captain  to  take  charge  of  her  who 
understands  navigation,  who  can  keep  his  run 
and  determine  his  place,  who  studies  the  weather 
and  is  on  the  lookout  for  a  lee  shore,  and  who  in 
emergencies  can  judge  whether  it  is  necessary 
or  not  to  cut  away  the  masts  or  throw  over  the 
cargo.  But  suppose  a  man  appears,  and  such 
have  been,  who  announces  that  he  has  a  specific 
bottle  of  oil  with  which  he  cures  tempests,  and 
by  pouring  a  teaspoonful  of  which  upon  the 
waves,  the  storm  is  speedily  made  to  cease  ! 
Would  any  prudent  owner  intrust  his  vessel  to 


TREATMENT    OF   DISEASE.  77 

such  a  man,  and  on  such  grounds,  even  though 
he  should  produce  a  hundred  certificates  that 
storms  had  stopped  in  half  a  day  or  half  an  hour 
after  the  application  of  his  remedy  ?  For  these 
certificates,  if  true,  would  only  prove  that,  in  a 
certain  number  of  cases,  a  result  had  followed  by 
accident,  which  common  sense,  and,  if  necessary, 
a  thousand  opposite  cases,  would  show  had  noth- 
ing to  do  with  the  pretended  cause. 

What  would  be  true  of  the  apparent  or  alleged 
cure  of  a  tempest  at  sea,  is  no  less  true  of  the 
pseudo-cures  which  every  day  take  place  in  dis- 
eases which  are  self-limited,  paroxysmal  or  recid- 
ivous  in  their  character.  There  are  doubtless 
living  many  men  who  believe  themselves  to  have 
been  cured  half  a  dozen  times  of  various  diseases, 
of  fevers  and  inflammations,  of  neuralgia,  rheu- 
matism, gout  and  asthma ;  and  each  time  perhaps 
by  a  different  remedy,  but  who,  on  the  next  im- 
prudence or  returning  period,  are  destined  to 
find  themselves  feverish,  neuralgic,  gouty,  or 
asthmatic  still. 

Deceptions  in  medicine  are  occasioned  not 
only  by  the  dishonesty  of  charlatans,  but  quite 
as  often  by  the  well-meaning  credulity  of  other 
7* 


78  TREATMENT   OF   DISEASE. 

practitioners,  whose  intellect  is  impulsive,  dr 
whose  education  has  been  unduly  curtailed.  It 
is  so  flattering  to  a  man's  self-love  to  believe  that 
his  chance  shots  have  sometimes  taken  effect, 
that  physicians  of  regular  position  may  pass  their 
lives  in  mere  speculative  and  random  efforts  at 
curing  diseases,  shutting  their  eyes  against  their 
own  failures,  and  not  allowing  themselves  to  con- 
sider that  in  a  certain  portion  of  successful  cases 
which  they  had  failed  to  understand,  the  disease 
in  truth  got  well  without,  or  perhaps  in  spite  of, 
their  misdirected  and  embarrassing  practice. 

Medicine  is  a  great  good  and  an  unquestiona- 
ble blessing  to  mankind,  when  it  is  administered 
by  discriminating  and  intelligent  hands  with  sin- 
cerity and  good  judgment.  It  disappoints  expect- 
ation, and  fails  to  accomplish  its  mission,  when 
the  agent  who  dispenses  it  falls  into  the  mistaken 
resource  of  professing  infallibility,  and  of  raising 
hopes  which  he  knows  not  how  to  accomplish. 
No  man  is  deemed  to  be  safe  in  his  worldly  affairs 
who  is  afraid  to  look  into  his  own  pecuniary  con- 
dition. Neither  is  a  physician  safe  in  his  practice 
or  his  reputation,  who  is  afraid  to  face  the  case 
of  his  patient  in  all  its  bearings.  That  man  is 


TEEATMENT   OF   DISEASE.  79 

most  to  be  relied  on  who  looks  calmly  and  under- 
standingly  at  the  emergency  before  him,  who 
knows  the  import  of  signs,  and  deduces  from 
them  the  probable  tenor  of  coming  events  ;  who 
is  aware  of  the  great  truth  that  all  men  must  die, 
but  is  also  aware  of  the  more  gratifying  truth  that 
most  sick  men  recover;  and  who,  in  particular 
exigencies,  inquires  of  his  reason  and  his  knowl- 
edge, in  which  of  these  two  immediate  categories 
his  patient  is  placed,  and  how  far  the  event  of 
the  case  is  within  his  control.  He  will  then  inter- 
fere or  he  will  wait,  he  will  act  or  he  will  forbear, 
as  he  only  knows  how  who  can  form  a  correct 
verdict  from  the  evidence  before  him,  and  who 
knows  the  immeasurable  good  or  harm  which 
hangs  on  medical  practice. 

The  vulgar  standard  of  medical  character  de- 
pends very  much  on  the  supposed  successful 
result  of  cases.  But  this  is  not  the  true  stand- 
ard, for  the  best  physicians  as  well  as  the  most 
popular  practitioners  often  lose  their  patients, 
and  even  their  own  lives,  from  common  diseases; 
while,  on  the  other  hand,  the  most  injudicious 
treatment  and  the  most  reckless  exposures  are 
not  unfrequently  survived.  Laennec  and  Bichat, 


80  TREATMENT   OF   DISEASE. 

two  of  the  most  distinguished  lights  of  modern 
medicine,  died  of  the  very  diseases  they  were 
themselves  investigating.  Preissnitz,  the  prince 
of  modern  empirics,  himself  a  robust  peasant, 
died  of  premature  disease  at  the  age  of  fifty-two, 
in  the  midst  of  his  own  water-cure.  It  is  well 
known  that  the  most  thronged  and  popular 
places  of  resort  for  grave,  difficult  and  intracta- 
ble cases,  are  those  from  which  there  are  most 
funerals.  On  the  other  hand,  men  support  life 
in  certain  cases  under  every  extreme  of  opposite 
treatment,  under  ultra-depletion  and  ultra-stimu- 
lation, under  heroic  practice  and  nugatory  prac- 
tice, under  "hot  drops"  and  cold  douches,  under 
drachm  doses  of  calomel  and  imponderable  doses 
of  moonshine.  Clot  Bey,  and  his  two  or  three 
associate  Frenchmen,  entered  a  plague  hospital 
at  Cairo  in  the  height  of  the  epidemic.  They 
shut  themselves  up  in  the  concentrated  atmos- 
phere of  the  infection,  they  remained  in  bed  in 
contact  with  dying  patients,  they  wore  the  shirts 
of  those  who  had  just  expired,  they  inoculated 
themselves  with  the  secretions  of  pestilential 
buboes,  —  and  all  to  no  purpose.  They  were 
alive  some  years  afterwards,  and  quarrelling 


TKEATMENT   OF   DISEASE.  81 

with  each  other  for  the  glory  of  their  hair- 
brained  enterprise.  Four  thieves  in  the  plague 
at  Marseilles  freely  prosecuted  their  robberies  in 
the  infected  houses  of  the  dead  and  dying ;  and 
the  aromatic  vinegar,  which  has  immortalized 
their  prophylactic  practice,  was  very  probably 
an  impromptu  invention  brought  forward  by  them 
to  procure  their  exemption  from  punishment. 

The  humility  which  we  may  learn  from  the  lim- 
ited influence  of  our  art  on  the  health  and  lives 
of  mankind  is  probably  a  far  safer  guide  to  a 
correct  practice,  than  the  fanatical  confidence 
with  which  unenlightened  ultraists  of  every  sect 
carry  out  their  respective  dogmas.  In  a  sphere 
of  action  where  some  good  may  always  be  done, 
and  where  much  harm  often  is  done,  and  "  fools 
rush  in  where  angels  fear  to  tread,"  it  is  well  to 
consider  some  of  the  rules  which  may  lead  an 
honest  inquirer  after  truth  to  the  nearest  attain- 
ment to  a  correct  judgment  and  practice. 

Supposing,  what  I  would  fain  wish  might  al- 
ways happen,  that  the  physician  is  duly  and  thor- 
oughly imbued  with  knowledge  of  his  science, 
the  first  great  question,  which  presents  itself  in 
every  case  or  emergency,  is  that  which  involves 


82  TREATMENT   OF   DISEASE. 

the  diagnosis.  This  being  established,  the  prac- 
titioner is  enabled  to  avail  himself  of  the  lights 
of  reason  and  experience  in  regard  to  a  correct 
course  of  therapeutic  proceeding.  But  it  often 
happens  that  the  nature  of  the  case  cannot  be 
made  out  in  one,  or  two,  or  three  interviews 
with  the  patient,  and  we  are  obliged  to  wait  for 
the  gradual  development  of  diagnostic  symptoms, 
as  a  judge  and  jury  in  a  like  case  would  be  ex- 
pected to  postpone,  or  wait  for  the  arrival  of 
witnesses.  It  is  a  mistaken  pride  which  leads 
physicians  to  commit  themselves  by  an  oracular 
guess  at  first  sight,  which  the  events  of  the  suc- 
ceeding day  may  show  to  have  been  erroneous. 
Moreover,  if,  from  the  obscure  character  of  the 
case,  or  the  imperfection  of  our  science,  diagnosis 
is  impossible,  we  should  then  so  generalize  our 
treatment  that  we  may  include  what  is  possible 
of  good,  and  exclude  what  is  probable  of  harm. 

Having  settled,  as  well  as  our  means  admit,' the 
pathological  condition  of  our  patient,  the  next 
question  is  that  which  regards  the  probable  ten- 
dency of  the  disease  if  left  to  itself.  Attention 
to  this  point  is  of  high  importance,  since  it  will 
prevent  us  from  neglecting  our  patients  in  grave 


TREATMENT   OP  DISEASE.  83 

and  dangerous  affections,  as  well  as  from  annoy- 
ing them  with  useless  appliances  in  short,  safe  or 
unimportant  cases.  Many  diseases  are  insidious 
in  their  origin.  The  nervous  imbecility  which 
has  its  foundation  laid  in  modern  schools,  the 
slight  cough  and  evening  flush  which  herald  ap- 
proaching phthisis,  soon  get  beyond  the  reach 
of  medical  means,  unless  seasonably  detected  by 
the  wary  eye  of  the  practitioner.  A  simple  dis- 
charge from  the  ear  may  terminate  in  deafness, 
and  an  ulcer  of  the  cornea  in  loss  of  sight.  A 
protracted  intermittent  at  length  undermines  the 
health,  and  neglected  syphilis  ends  in  a  miserable 
death.  Cases  like  these  require  prompt  and  en- 
ergetic interference  on  the  part  of  the  practi- 
tioner. On  the  other  hand,  diseases  which  are 
light  in  themselves,  and  tend  to  speedy  recov- 
ery, as  common  catarrh,  hooping-cough,  varicella, 
and  a  host  of  other  things,  if  they  occur  in 
healthy  subjects,  and  are  not  complicated  with 
graver  affections,  may  safely  be  left  to  them- 
selves, or  treated  with  the  mildest  remedies  and 
cautionary  measures. 

Another  most  important  question,  exercising 
the  hopes  and  fears  of  every  practitioner,  from 


84  TREATMENT   OF  DISEASE. 

its  connection  with  reputation,  safety  and  life,  is 
that  which  relates  to  the  curability  of  diseases. 
Is  the  disease  amenable  to  medical  treatment,  or 
not  ?  If  the  case  is  of  a  recoverable  character, 
and  happily  a  great  majority  of  our  cases  are  so, 
the  physician  should  anxiously  and  carefully 
have  recourse  to  the  recorded  authorities  of  his 
science,  and  to  his  own  personal  experience.  In 
doing  this  he  should  beware  of  implicitly  trust- 
ing those  who  have  published  only  the  favorable 
side  of  their  practice,  preferring  to  build  up  a 
temporary  reputation  rather  than  to  promulgate 
unpopular  truths.  And,  in  analyzing  his  own  ex- 
perience, he  should  equally  beware  of  hasty  gen- 
eralizations, of  impressions  made  by  remarkable 
examples,  rather  than  by  aggregates  of  well  ob- 
served and  duly  arranged  cases,  from  which 
alone  impartial  and  correct  inferences  are  to 
be  drawn. 

In  accordance  with  such  views,  we  shall  find 
many  cases  which  are,  for  the  most  part,  capable 
of  being  arrested  or  broken  up  by  the  interposi- 
tion of  remedies.  Thus,  the  grave  and  various 
symptoms  which  result  from  an  overloaded  stom- 
ach are  at  once  removed  by  the  action  of  an 


TREATMENT   OF  DISEASE.  85 

emetic,  or  sometimes  of  a  laxative  ;  colic  in  like 
manner  yields  to  opium  or  to  purgatives;  syphilis 
is  cured  by  mercury,  and  sometimes  without  it ; 
and  certain  inflammatory  attacks  apparently  yield 
to  seasonable  depletion.  Moreover,  in  other  cases 
which  cannot  be  thus  arrested,  but  which,  from 
their  nature,  must  run  a  destined  course,  it  is 
generally  admitted  that  the  safety  of  the  patient 
may  be  promoted,  or  perhaps  the  duration  of  the 
case  abridged,  by  remedial  treatment.  This  is 
believed  to  be  true  in  regard  to  evacuations  at 
the  commencement  of  febrile  and  inflammatory 
diseases,  and  to  a  multitude  of  other  remedies 
applicable  in  various  cases.  But  on  this  subject 
it  is  extremely  difficult  to  obtain  decisive  and 
satisfactory  knowledge.  It  involves  a  question, 
the  settlement  of  which  is  to  be  approached  by 
extensive  and  contrasted  numerical  observations, 
a  large  portion  of  which  yet  remain  to  be  made, 
although  we  have  valuable  contributions  and 
examples  on  many  subjects. 

On  the  other  hand,  when  we  know  that  a  case 
is  self-limited  or  incurable,  we  are  to  consider 
how  far  it  is  in  our  power  to  palliate  or  diminish 
sufferings  which  we  are  not  competent  to  re- 


86  TREATMENT   OF   DISEASE. 

move.  Here  is  a  most  important  field  for  medi- 
cal practice,  and  one  which  calls  for  an  exceed- 
ingly large  portion  of  the  time  and  efforts  of 
every  physician.  When  we  consider  that  most 
diseases  occupy,  from  necessity,  a  period  of  some 
days  or  weeks,  that  many  of  them  continue  for 
months,  and  some  for  years,  and  finally  that  a 
large  portion  of  mankind  die  of  some  lingering 
or  chronic  disease,  we  shall  see  that  the  study 
of  palliatives  is  not  only  called  for,  but  really 
constitutes  one  of  the  most  common,  as  weh1  as 
the  most  useful  and  beneficent  employments  of  a 
medical  man. 

In  the  use  of  efficient  remedies,  much  depends 
upon  deciding  the  proper  stage  or  time  to  which 
their  employment  is  applicable.  Some  curative 
agents  can  with  propriety  be  used  only  at  the 
outset  of  the  diseases,  and  if  this  opportunity  is 
lost,  the  remedies  are  afterwards  less  effectual, 
and  perhaps  even  injurious.  Venesection,  in  the 
early  stage  of  certain  acute  diseases,  may  be  pro- 
ductive of  great  good  ;  in  the  middle  stages  it  is 
of  less  benefit,  or  of  none  at  ah1 ;  and  in  the  latter 
stages  it  is  injurious  and  inadmissible.  On  the 
other  hand,  wine  and  opiates,  which  are  strongly 


TREATMENT    OF   DISEASE.  87 

contra-indicated  in  the  first  stage,  are  afterwards 
not  only  tolerated  with  impunity,  but  in  certain 
cases  are  taken  with  decided  benefit. 

But,  gentlemen,  the  agents  which  we  oppose 
to  the  progress  of  disease  may,  by  excessive  or 
ill-timed  application,  become  themselves  the  preg- 
nant sources  of  disease.  Every  prudent  practi- 
tioner is  bound  to  consider  the  effect  and  ten- 
dency of  the  remedy  he  is  using,  and  to  inquire 
whether  the  means  employed  to  counteract  the 
existing  disease  are  not,  in  their  turn,  likely  to 
produce  evil  to  the  patient ;  and,  if  so,  whether 
the  evil  will  be  greater  or  less  than  the  disease 
for  which  they  are  administered.  The  sudden 
healing  of  an  old  iilcer,  issue  or  eruption,  may 
be  followed  by  symptoms  more  serious  in  their 
character  than  those  which  have  been  removed. 
Many  remedial  processes,  if  employed  in  excess, 
or  with  injudicious  frequency,  result  in  perma- 
nent injury  to  the  patient.  The  habitual  use  of 
active  cathartics,  although  attended  with  tempo- 
rary relief,  seldom  fails  to  bring  on  or  aggravate 
a  permanent  state  of  costiveness.  Large  and 
often  repeated  blood-letting  tends  to  the  estab- 
lishment of  debility  and  anemia  in  some  subjects, 


00  TREATMENT   OF   DISEASE. 

or  of  reaction  and  plethora  in  others.  Opium 
and  other  narcotics  are  in  themselves,  if  abused, 
fertile  sources  of  disease.  The  modern  crying 
evil  of  polypharmacy  and  over-medication  is 
profitable  to  the  druggist,  habitual  to  too  many 
physicians,  and  annoying,  if  not  detrimental,  to 
most  patients. 

On  account  of  these  and  similar  considerations, 
much  discretion  is  needed  on  the  part  of  the  phy- 
sician to  enable  him  to  judge  rightly  of  the  kind 
of  treatment  which  it  may  be  safe  and  proper  to 
employ,  and  of  the  degree  and  amount  of  that 
treatment,  and  of  the  requisite  length  of  time  for 
its  continuance.  Medical  practice,  in  many  cases, 
points  to  the  direct  substitution  of  a  positive 
good  for  a  positive  evil ;  but  unfortunately,  in 
other  cases,  it  admits  only  of  a  choice  between 
evils  ;  and  in  these  cases  not  only  the  knowledge 
and  experience,  but  also  the  judgment  and  com- 
mon sense  of  the  practitioner,  are  put  in  indis- 
pensable requisition  to  lead  him  to  a  correct 
issue. 

It  is  wrong  to  suppose,  as  is  often  done,  that 
the  opportunities  for  doing  good  in  medicine 
are  limited  to  the  effect  of  specific  remedies,  or 


TREATMENT   OF  DISEASE.  89 

to  the  application  of  drugs  and  instruments. 
The  enlightened  physician  surveys  the  whole 
ground  of  his  patient's  case,  and  looks  for  the 
presence  of  any  deleterious  agencies  or  unre- 
moved  causes  of  disease.  Many  morbid  affec- 
tions, which  have  resisted  powerful  remedies, 
cease  speedily  on  the  discovery  and  removal  of 
their  sustaining  cause.  This  is  the  case  with 
various  specific  complaints  produced  by  particu- 
lar drugs  and  stimulants  when  habitually  used. 
A  child  is  often  sick  from  an  error  in  the  diet, 
health  or  habits  of  the  nurse  or  mother.  An  in- 
dividual frequently  suffers  from  the  quality  and 
quantity  of  his  habitual  food  or  drink,  or  of  his 
exercise,  air,  occupation,  or  clothing.  The  starved 
infant  and  the  overfed  gourmand,  the  drunkard 
and  the  ascetic,  the  pale  student  and  the  ema- 
ciated seamstress,  require  removal  and  reform, 
not  drugs  and  medicines.  A  patient  dies  of 
phthisis  in  a  confined  office  or  a  damp  northern 
climate,  who  might  have  enjoyed  long  life  in  an 
active  occupation  or  a  more  pure  and  temperate 
atmosphere.  On  the  other  hand,  men  fall  victims 
to  the  fevers  and  abdominal  diseases  of  the  south 
and  west,  who  might  have  escaped  disease  by  a 
8* 


90  TREATMENT   OF  DISEASE. 

timely  removal  to  the  north.  It  is  as  necessary 
in  many  cases  that  the  physician  should  inquire 
into  the  situation,  diet,  habits  and  occupation  of 
the  patient,  as  that  he  should  feel  his  pulse  or 
explore  his  chest.  It  often  happens  that  the 
disordered  state  of  the  one  cannot  be  corrected 
until  the  other  has  been  previously  set  right ; 
and  a  little  dietetic  instruction,  or  even  moral 
advice,  is  more  serviceable  than  a  technical 
prescription. 

In  regard  to  their  duration,  their  probable  is- 
sue, and  their  susceptibility  of  relief,  the  physi- 
cian may  profitably  divide  his  cases  into  three 
classes ;  those  which  are  curable,  those  which 
are  temporarily  self-limited,  and  those  which  are 
incurable.*  In  the  first  class,  or  that  of  curable 
diseases,  are  to  be  included  those  morbid  affec- 
tions which  we  know,  or  have  reason  to  believe, 
are  under  the  control  of  remedies,  so  that  they 
can  be  arrested,  or  abridged,  in  duration.  For 
the  most  part,  acute  inflammatory  diseases,  when 
not  of  fatal  intensity,  are  mitigated  by  depletion 
and  the  antiphlogistic  regimen,  more  or  less  ac- 

*  See  note,  page  21. 


TREATMENT   OF  DISEASE.  91 

tively  enforced,  according  to  the  degree  of  vio- 
lence. Spasmodic  diseases,  on  the  contrary,  are 
influenced  by  opiates,  antispasmodics  and  tonics, 
and  by  the  removal  of  their  cause,  when  it  can 
be  discovered  and  remedied,  as  in  the  case  of 
dentition,  indigestible  food,  <fec.  Sympathetic 
diseases  are  to  be  addressed  through  the  medi- 
um, organ,  or  texture,  which  is  primarily  affected. 
Thus,  a  headache  depending  upon  a  disordered 
stomach,  or  a  hysteric  affection  upon  irregularity 
of  the  uterine  function,  are  to  be  treated  under 
this  view  of  the  subject.  Hemorrhages  and  other 
morbid  discharges  are  to  be  dealt  with  by  re- 
moving the  cause  when  practicable,  by  diminish- 
ing vascular  activity,  or  by  quieting  the  discharg- 
ing surfaces  with  opiates,  or  contracting  them 
with  astringents.  There  is  one  class  of  curable 
diseases  which  are  controlled  chiefly  by  specific 
remedies,  being  in  some  instances  suspended,  in 
others  radically  removed.  Thus,  gout  is  relieved 
by  colchicum,  and  intermittents,  it  is  believed,  by 
quinine.  Scabies  is  cured  by  sulphur,  syphilis  by 
mercury,  goitre,  as  we  are  informed,  by  iodine, 
and  various  chronic  eruptions  by  arsenic  and 
corrosive  sublimate.  The  foregoing  examples 


92  TREATMENT   OF  DISEASE. 

will  serve  to  illustrate,  not  only  the  power  of 
medicine,  but  also  the  great  variety  of  grounds 
which  should  govern  medical  practice,  and  the 
importance  of  an  intelligent  diagnosis,  as  well  as 
a  knowledge  of  therapeutic  means. 

In  the  next  subdivision,  or  that  of  self-limited 
diseases,  we  include  those  "  which  receive  limits 
from  their  own  nature,  and  not  from  foreign 
influences,  and  which,  after  they  have  obtained 
foothold  in  the  system,  cannot  in  the  present 
state  of  our  knowledge  be  eradicated  or  abridged 
by  art,  but  to  which  there  is  due  a  certain  suc- 
cession of  processes,  to  be  completed  in  a  certain 
time,  which  tune  and  processes  may  vary  with  the 
constitution  and  condition  of  the  patient,  but  are 
not  known  to  be  shortened  by  medical  treat- 
ment." Examples  are  abundant,  and  are  found 
in  typhus  and  typhoid  fever,  measles,  small-pox, 
hooping-cough,  dysentery,  and  many  other  dis- 
eases of  lighter  or  graver  character.* 

It  is  with  regret  that  we  are  obliged  to  ac- 
knowledge the  existence  of  a  third  class,  that  of 
incurable  diseases,  which  has  been  recognized  in 

*  See  marginal  note,  page  31. 


TREATMENT   OF   DISEASE.  93 

all  ages  as  the  opprobrium  medicorum.  It  in- 
cludes the  long  train  of  internal  morbid  degen- 
erations, malignant  and  chronic,  by  tubercle  and 
granulation,  by  atrophy  and  hypertrophy,  soften- 
ing and  hardening,  scirrhus,  encephalosis,  ossifi- 
cation, concretion,  contraction  and  dilatation, 
with  their-  various  consequences  of  phthisis, 
emphysema,  dropsy,  epilepsy,  paralysis,  and  a 
multitude  of  intractable  disorders,  in  which  or- 
gans are  disabled,  functions  destroyed,  and  life 
itself  rendered  incapable  of  continuance. 

It  is  obvious  that  in  the  three  foregoing  classes 
of  disease  very  different  modifications  of  treat- 
ment are  required.  In  curable  diseases,  our 
remedial  measures  should  be  prompt  and  ener- 
getic in  proportion  to  the  emergency  of  the  case, 
and  the  certainty  of  benefit  which  is  to  follow 
their  employment.  In  self-limited  diseases,  our 
treatment  must  be  of  the  expectant  character. 
It  consists  in  doing  what  we  can  for  the  comfort 
and  safety  of  the  patient,  avoiding  useless  and 
troublesome  applications,  watching  against  acci- 
dents and  complications,  and  waiting  for  the  sal- 
utary operations  of  nature.  In  those  maladies 
which  are  in  their  nature  incurable,  we  are 


94  TREATMENT   OF  DISEASE. 

obliged  to  confine  ourselves  to  the  palliation  of 
suffering,  and  the  removal  of  causes  which  may 
aggravate  the  disease. 

Such,  I  believe,  is  the  true  exposition  of  the 
powers  and  duties  of  every  medical  man.  The 
dignity  of  our  science,  and  the  responsibility  of 
our  profession,  require  that  we  should  form  just 
views  of  the  extent  of  our  capacity  and  duty, 
and  that  we  should  not  shrink  from  avowing 
them  to  the  world.  Our  science,  imperfect  as 
it  is,  has  achieved  as  much  as  any  similar  science 
for  the  prevention,  alleviation  and  removal  of 
the  evils  which  it  combats.  Let  us  not  bring  it 
into  disrepute,  by  pretending  to  impossibilities, 
by  asserting  what  cannot  be  proved,  and  by  pro- 
fessing what  human  art  is  unable  to  accomplish. 
A  new  era  will  dawn  upon  medicine  when  its 
faithful  and  enlightened  cultivators  shall  more 
constantly  devote  their  tune  and  their  efforts  to 
enlighten  the  public  mind  in  regard  to  the  true 
mission  and  powers  of  their  science ;  and  when 
they  shall  leave  to  charlatans  and  fanatics  the 
doubtful  and  dishonest  game  of  unfounded  pro- 
fessional pretension. 


PRACTICAL    VIEWS 

ON 

MEDICAL    EDUCATION. 

PUBLISHED     BY    VOTE    OF    THE    MEDICAL     FACULTY     OF     ILABVABD 
UNIVERSITY   IN   1850. 


THE  undecided  state  of  public  opinion  in 
regard  to  some  of  the  fundamental  points  in  a 
course  of  medical  education,  including  among 
other  things  the  portion  of  the  term  of  pupilage 
proper  to  be  spent  in  attendance  on  lectures,  is 
thought  to  justify  a  further  consideration  of  the 
subject.  In  some  of  its  relations,  this  subject 
has  already  been  discussed,  in  the  Transactions 
of  the  American  Medical  Association  for  1849, 
in  two  reports,  pages  353  and  359,  to  which  the 
reader  is  particularly  referred.  The  following 
condensed,  but  more  general  view  of  the  subject 
of  medical  education  is  now  respectfully  sub- 
mitted to  the  members  of  the  Association. 


96 


Medical  instruction  should  be  adapted  to  the 
power  of  students  to  receive  and  retain  what  is 
communicated  to  them,  and  should  be  confined 
to  what  is  important  to  them  in  their  subsequent 
life. 

In  modern  times  the  constituent  branches  of 
medical  science  are  so  expanded,  that  they  are 
not  acquired  by  any  physician  in  a  lifetime, 
and  still  less  by  a  student  during  his  pupilage. 
The  same  is  true  even  of  many  individual 
branches.  It  is  not,  therefore,  to  be  conceded 
that  "a  scheme  of  scientific  instruction  should 
embrace  the  whole  science,  and  no  part  should 
be  omitted ; "  nor  that  "  a  well-digested  plan  of 
lectures  embraces  all  that  is  to  be  known  and 
taught."  Medical  science  has  at  this  day  become 
so  unwieldy,  and  contains  so  much  that  is  un- 
necessary, at  least  to  beginners,  that  the  attempt 
to  explain  to  students  the  whole  is  likely  to 
involve  the  result  of  their  learning  but  little. 

In  Chemistry,  at  the  present  tune,  a  thorough 
adept  is  unknown.  No  man  living  knows  all  the 
recorded  facts,  or  all  that  is  to  be  known  and 
taught,  in  that  science.  Organic  chemistry  alone 
fills  large  volumes,  though  yet  in  its  infancy. 


ON  MEDICAL   EDUCATION.  97 

In  Materia  Medica  there  are  some  thousands 
of  substances  and  their  compounds,  which  pos- 
sess what  is  called  a  medicinal  power.  Yet  it 
is  not  probable  that  any  physician  effectively 
reads  the  one  half,  or  remembers  one  quarter,  or 
employs  in  his  yearly  practice  one  tenth,  of  the 
contents  of  the  common  dispensatories. 

In  Pathology,  so  complicated  and  various  are 
the  conditions  attendant  on  the  individual  forms 
of  disease,  and  their  relations  with  idiosyncrasy, 
temporary  condition,  and  external  agency,  with 
organic  lesions  and  functional  disturbances,  that 
few  of  the  most  experienced  pathologists  can  be 
said  to  understand  their  whole  science,  or  to  be 
always  competent  to  its  successful  application. 

In  Etiology,  the  theoretical  literature  of  causes 
has  spread  itself  out  to  an  extent  which  is  bur- 
densome and  unprofitable.  It  is  true  that  "  man, 
from  his  nature,  is  subject  to  suffering,  disease, 
and  death ; "  but  it  is  not  equally  apparent  that 
"  the  causes  by  which  these  conditions  are  pro- 
duced are  ascertainable."  We  know  nothing  of 
the  vehicle  of  cholera  or  influenza,  nor  is  it  prob- 
ably in  the  power  of  any  physician,  by  any  art 
or  application  of  his  knowledge,  to  produce  in  a 
9 


98  PEACTICAL    VIEWS 

given  healthy  man  a  case  of  common  pneumonia 
or  of  acute  rheumatism,  of  diabetes  or  Bright's 
kidney,  of  hypertrophy  or  of  cancer,  or  even  of 
a  common  boil,  or  wart. 

In  Therapeutics,  many  hundred  volumes  exist, 
such  as  would  not  have  existed,  could  a  knowl- 
edge of  the  cure  of  diseases  be  made  so  easily 
tangible  that  it  could  be  spread  before  the  stu- 
dent in  the  three  or  five  years  of  his  pupilage. 

In  Anatomy,  general  and  special,  microscopic 
and  transcendental,*  —  in  Physiology,  with  its 
intricate  ramifications  ;  —  in  Surgery,  of  which 
several  subordinate  specialities  constitute  dis- 
tinct living  professions ;  it  is  not  to  be  admitted 
that  the  means  or  time  of  any  ordinary  course 
of  lectures  can  furnish  full  and  complete  instruc- 
tion. Certainly  it  must  be  difficult  to  arrange  a 
course  of  lectures  on  any  of  the  extensive  sci- 
ences which  now  constitute  medicine,  if  it  be 
indeed  true  that  "  the  teachers  are  not  justifiable 
in  suppressing  any  portion." 

It  is  the  business  of  lecturers  in  medical 
schools  to  condense  and  abridge  the  sciences 
which  they  respectively  teach,  to  distinguish 
their  essential  and  elementary  principles,  to  sift 


ON  MEDICAL  EDUCATION.  99 

carefully  the  useful  from  the  superfluous,  and  to 
confine  the  scope  of  their  teachings,  as  far  as 
possible,  to  what  is  true  and  profitable,  and 
likely  to  be  remembered  and  used  by  their 
hearers.  It  is  unfortunately  too  true,  that,  "  in 
an  extended  system  of  instruction,  there  is  much 
that  the  student  will  not  master,  much  that  will 
have  escaped  his  attention,  much  which  he  ought 
to  know  that  he  has  not  learned."  The  remedy 
appears  to  be,  to  teach  him  well  what  he  can  and 
should  master,  and  briefly  to  point  out  to  him 
the  sources,  fortunately  abundant,  from  which  he 
may  obtain  the  rest. 

Much  injury  is  done  to  the  cause  of  true 
learning  by  medical  assumption,  amplification 
and  exaggeration,  by  premature  adoption  of 
novelties,  and  by  tenacity  of  theories,  personal 
or  espoused.  Students,  in  all  former  years,  have 
expended  much  time  in  learning  what  it  after- 
wards cost  them  both  time  and  trouble  to 
unlearn ;  —  in  acquiring,  not  merely  the  truths 
of  science,  but  the  crude  announcements  and 
plausible  doctrines  of  sanguine  or  ingenious 
men.  How  much  time  has  been  wasted,  in  some 
of  our  distinguished  seminaries,  in  acquiring  the 


100  PRACTICAL   VIEWS 

visionary  and  now  neglected  theories  of  Rush 
and  Broussais ! 

The  most  commonly  exaggerated  branch  of 
medical  science  is  therapeutics.  Enlightened 
physicians  well  know  that  many  diseases  are 
incurable,  and  that  others  are  subject  to  laws  of 
duration  which  cannot  be  interrupted  by  art. 
Yet  students  sometimes  return  from  medical 
schools  persuaded  that  their  instructors  know 
how  to  cure  a  large  part  of  these  diseases,  and 
that,  if  others  are  less  fortunate,  it  is  attributable 
to  their  own  fault. 

Medical  teachers  should  keep  pace  with  the 
progress  of  their  respective  sciences.  Yet,  in 
their  haste  for  the  promulgation  of  novelties, 
they  should  not  omit  to  give  the  proper  consid- 
eration to  the  older  and  more  settled  principles 
of  science.  Medical  men  are  liable  to  commit 
the  error  of  adopting  premature  opinions,  un- 
sound practice,  and  inconvenient  changes  of 
language  and  nomenclature,  sometimes  from  a 
love  of  display,  and  sometimes  from  a  want  of 
self-reliance,  and  a  fear  of  being  thought  behind 
the  literature  of  their  time. 

The  length  of  a  course  of  lectures  is  not  the 


OX   MEDICAL    EDUCATION.  101 

measure  of  its  value  to  the  student.  A  course 
of  lectures  should  not  outlast  the  curiosity  of 
its  hearers,  nor  their  average  pecuniary  ability 
to  attend.  Custom  in  this  country  has  generally 
fixed  the  limits  of  these  things  at  about  four 
months.  A  comprehensive  and  judicious  course, 
confined  to  the  enforcing  of  necessary  points, 
is  far  more  profitable  than  a  more  discursive 
course  to  a  wearied  and  diminishing  audience. 

Lectures  are  chiefly  wanted  to  impress  by 
demonstration  the  practical  branches  of  science, 
and  they  are  most  effective  in  places  where  the 
facilities  for  such  demonstrations  can  be  com- 
manded. Anatomy  requires  extensive  exhibi- 
tions by  the  teacher,  and  personal  dissections  by 
the  student.  Chemistry  and  Materia  Medica 
require  illustrations  by  specimens  and  experi- 
ments. Pathology  needs  the  aid  of  autopsies, 
museums  and  the  clinical  demonstrations  of 
large  hospitals.  A  knowledge  of  Obstetrics  is 
not  perfected  without  apparatus  and  practice. 
Surgery  is  acquired  by  witnessing  numerous 
operations,  surgical  diseases,  illustrated  explana- 
tions, and  by  personal  practice  on  the  dead 
body.  Physical  exploration  is  wholly  demon- 
9* 


102  PRACTICAL   VIEWS 

strative.  A  knowledge  of  auscultation  can  no 
more  be  acquired  from  books,  or  abstract  lec- 
tures, than  a  knowledge  of  music,  or  of  individ- 
ual physiognomy. 

The  intermediate  period  between  lectures 
should  be  spent  by  students  in  active  and  origi- 
nal study,  approved  and  confirmed  by  regular 
recitations,  and  by  such  opportunities  as  can  be 
commanded  for  practical,  personal  experience. 
Private  schools  for  small  classes,  and  the  private 
teaching  of  individuals  who  are  suitably  quali- 
fied and  situated,  are  more  advantageous  for  two 
thirds  of  the  year,  than  either  the  fatiguing 
jostle  of  overcrowded  rooms,  or  the  listless  rou- 
tine kept  up  by  the  survivors  of  a  passive  class. 

The  usefulness  of  a  medical  school  depends 
not  so  much  on  the  length  of  its  session  as 
upon  the  amount  of  education,  preliminary  and 
ultimate,  which  it  requires,  the  fidelity  with 
which  it  exacts  its  own  professed  requisitions, 
and  the  train  of  healthy  exertion,  active  inquiry, 
and  rigid,  methodical,  self-regulating  study,  to 
which  it  introduces  its  pupils.  The  longest 
lectures  are  of  little  use  to  students  who  want  a 
common  education,  and  whose  medical  educa- 


ON   MEDICAL   EDUCATION.  103 

tion  does  not  qualify  them  afterwards  to  observe, 
to  inquire,  and  to  discriminate.  The  exacted  evi- 
dence of  three  years  of  well-conducted  study  is 
better  than  the  exhibited  ticket  of  a  six  months' 
course. 

The  subjects  most  important  to  be  well  taught 
in  medical  schools  are  the  elementary  principles 
which  constitute  the  framework  of  medical  sci- 
ences, and  the  mode  of  thought  and  inquiry  which 
leads  to  just  reasoning  upon  them.  After  these, 
most  attention  should  be  given  to  selecting  and 
enforcing  such  practical  truths  as  will  most  cer- 
tainly be  wanted  by  the  young  practitioner  in 
his  future  career  of  responsibility. 

The  things  to  be  avoided  by  medical  teachers 
are  technicalities,  which  are  unintelligible  to  be- 
ginners,—  gratuitous  assumptions  and  citations 
of  doubtful  authorities,  —  prolix  dissertations  on 
speculative  topics,  —  excessive  minuteness  in  re- 
gard to  subjects  which  are  intricate  and  but  little 
used,  and  therefore  destined  to  be  speedily  for- 
gotten. To  these  may  be  added  controversies, 
superfluous  personal  eulogiums  and  criminations, 
and  all  self-exaggeration,  personal  or  local. 


REPORT  ON  HOMCEOPATHY: 


MADE     TO     THE     COUNSELLOES      OF     THE     MASSACHUSETTS     MEDICAL 
SOCIETY    IN    FEBRUARY,    1854. 


THE  committee  appointed  by  the  Counsellors 
of  the  Massachusetts  Medical  Society,  to  con- 
sider the  resolution  of  the  Essex  North  District 
Society,*  and  also  that  of  Dr.  Spofford,  in  rela- 
tion to  the  subject  of  Homoeopathy,  beg  leave  to 
Report :  — 

That  the  Massachusetts  Medical  Society  was 
incorporated  mainly  for  the  purpose  of  estab- 
lishing a  proper  standard  of  medical  education, 
and  of  insuring  a  competent  degree  of  knowl- 
edge among  those  who  should  be  authorized  to 
practise  the  profession  of  medicine  in  this  Com- 
monwealth, and  they  are  not  aware  that  the 

*  These  resolutions  contemplated  dissolving  the  connection  of 
Homceopathists  with  the  Society. 


EEPOET   ON   HOMOEOPATHY.  105 

Society  possess  any  power  to  coerce  men,  after 
they  have  been  thus  educated  and  qualified,  to 
embrace,  or  renounce,  any  theoretical  opinions, 
or  modes  of  practice,  which  they  may  innocently 
believe,  or  which,  not  believing,  they  may  think 
it  proper  to  profess. 

In  medical  science  there  are  certain  fundamen- 
tal laws  relating  to  the  structure  and  functions 
of  the  body,  and  the  morbid  changes  to  which 
it  is  subject,  also  regarding  the  signs  by  which 
those  changes  are  discovered,  —  upon  which  all 
well-educated  physicians  are  agreed.  But  in 
certain  provinces  of  medical  science  such  funda- 
mental laws,  owing  to  the  imperfection  of  our 
means  of  knowledge,  cannot  at  the  present  time 
be  established.  This  is  the  case  with,  Therapeu- 
tics, or  the  art  of  treating  or  curing  diseases,  in 
which  the  evidence  required  by  science  is  diffi- 
cult to  obtain,  and  in  regard  to  which  writers 
and  teachers,  sects  and  individuals,  and  even  the 
same  individual  in  the  course  of  an  ordinary  life- 
time, may  without  dishonesty  entertain  great 
diversities  of  opinion. 

The  tendency  of  modern  observation  is  such 
as  to  lead  us  to  the  belief  that  disease  is  less 


106  EEPOET    ON   HOMCEOPATHY. 

frequently  under  the  control  of  remedial  treat- 
ment than  it  was  formerly  supposed  to  be. 
Where  observations  are  impartially  made  by 
competent  persons,  it  is  found  that  people  re- 
cover, and  also  that  they  die,  under  all  the  ordi- 
nary modes  of  treatment.  And  the  evidence 
collected  from  sources  which  are  worthy  of  reli- 
ance is  not  so  abundant  or  satisfactory  as  to  con- 
vince a  reasonable  man  that  any  general  system 
of  practice  can  be  relied  on  for  the  cure  of  all 
cases.  Hence,  it  is  not  surprising  that  diversities, 
contrasts,  and  even  extravagances  in  practice,  are 
embraced  by  the  sanguine,  the  credulous,  the 
uninformed  and  the  interested,  frequently  based 
upon  no  better  authority  than  accident,  imperfect 
observation,  or  defective  power  of  judgment  in 
the  party  who  adopts  them. 

The  broadest  division  which  has  been  recog 
nized  for  centuries,  in  the  treatment  of  disease,  is 
that  which  resolves  the  whole  subject  into  the 
active  and  the  expectant  modes  of  practice.  The 
first  employs  various  interfering  agencies  in  the 
management  of  the  sick, — the  last  waits  more  on 
the  unassisted  course  of  nature,  —  and  both  have 
long  had  their  exclusive  advocates. 


REPORT   ON   HOM030PATHY.  107 

To  the  last  of  these  divisions  Homoeopathy 
really,  though  not  avowedly,  belongs.  Its  char- 
acter is,  that,  while  in  reality  it  waits  on  the 
natural  course  of  events,  it  commends  itself  to 
the  ignorant  and  credulous  by  a  professed  intro- 
duction into  the  body  of  inappreciable  quantities 
of  medicinal  substances.  Now  the  nugatory 
effect  of  such  quantities  is  demonstrated  by  the 
fact  that  in  civilized  life  every  person  is  exposed 
to  the  daily  reception,  in  the  form  of  solution, 
dust  or  vapor,  of  homceopathic  quantities  of 
almost  every  common  substance  known  in  nature 
and  art,  without  any  appreciable  consequences 
being  found  to  follow.  And  the  pretended  exact- 
ness with  which  such  nominal  doses  are  adminis- 
tered by  homceopathic  practitioners  is  doubtless 
a  fallacy,  capable  of  producing  in  the  living  body 
no  other  effects  than  those  which  charlatanry  has 
in  all  ages  produced  in  the  minds  and  bodies  of 
imaginative  patients. 

It  is  a  fact  much  older  than  the  institution  of 
this  Society,  that  visionary  systems  of  practice 
have  replaced  each  other  in  the  faith  of  multi- 
tudes, at  least  several  times  in  a  century.  And 
this  will  probably  be  the  case,  so  long  as  prao 


108  EEPORT   ON   HOMOEOPATHY. 

tical  medicine  continues  to  be,  what  it  now  is  to 
a  great  extent,  a  theoretical  and  conjectural  sci- 
ence. At  the  present  period,  among  the  sects 
usually  called  irregular,  the  homoeopathic  sect 
prevails  to  a  considerable  extent  in  this  country 
and  in  Europe.  In  the  United  States  it  is  ex- 
ceeded only  by  the  sect  called  Botanic,  or  Thomp- 
soniaii  practitioners,  which  at  the  present  time 
appears,  of  the  two,  to  number  most  disciples. 
It  is  not  probable  that  the  faith  of  either  of  these 
sects  will  be  displaced  by  a  return  of  their  fol- 
lowers to  any  more  enlightened  or  rational  creed. 
Nevertheless,  it  is  safe  to  predict  that  they  will 
both  be  superseded  in  the  course  of  time  by 
other  systems,  not  more  rational  or  probable  in 
themselves,  but  possessing  the  attraction  of 
greater  novelty,  or  urged  upon  the  credulous 
with  greater  adroitness.  "When  the  world,  and 
especially  the  unenlightened  part  of  it,  shall  be 
settled  in  their  opinions  on  other  sectarian  sub- 
jects, we  may  anticipate  unanimity  of  opinion 
among  them  in  the  science  of  practical  medicine. 
But  it  is  not  only  to  expectant  medicine,  in 
the  form  of  its  counterfeit,  homoeopathy,  that 
the  censure  of  prejudice  and  credulity  is  to  be 


EEPOET  ON   HOMOEOPATHY.  109 

attached.  The  opposite  system  of  active  prac- 
tice, carried  to  the  extreme  usually  called  heroic, 
is  alike  chargeable  with  evil  to  the  patients, 
whenever  it  becomes  the  absorbing  and  exclu- 
sive course  of  the  practitioner.  Physicians  are 
too  often  led  to  exaggerate  the  usefulness  of  the 
doctrines  in  which  they  have  been  educated,  and 
especially  of  those  by  the  exercise  of  which  they 
obtain  their  daily  bread.  In  such  cases  habit 
gets  the  ascendency  over  enlightened  judgment, 
and  the  man  of  routine,  or  of  narrow  views,  asks 
himself,  from  day  to  day,  what  drug  or  what  ap- 
pliance he  shall  next  resort  to,  instead  of  asking 
the  more  important  question,  whether  any  drug 
or  any  appliance  is  called  for,  or  is  properly 
admissible  in  the  case. 

In  Medicine,  as  in  the  other  inexact  sciences 
which  deeply  concern  the  welfare  of  mankind, 
enough  has  been  learned  to  show  that  extreme 
measures,  either  of  omission  or  of  commission, 
are  not,  when  systematized  as  a  whole,  produc- 
tive of  benefit  or  safety  to  mankind. 

It  is  quite  probable  that  the  prevalence,  at 
times,  of  eccentric  and  ultra-sectarian  doctrines 
in  medicine,  is  attributable  to  the  exaggerated 
10 


110  REPORT   ON   HOMOEOPATHY. 

value  attached  by  physicians  themselves  to  inces- 
sant activity  in  practice,  and  an  assumption  of 
credit  for  particular  modes  of  medication,  to 
which,  as  such,  they  are  not  entitled.  There  is 
often  a  want  of  openness  in  the  intercourse  of 
physicians,  both  enlightened  and  ignorant,  with 
their  patients,  who  are  requested  to  believe  that 
their  cure  depends  not  in  any  degree  on  the  sal- 
utary influences  of  nature  and  time,  but  in  the 
rigid  enforcement  of  a  prescribed  routine  of 
practice,  either  active  or  formal,  as  the  case  may 
be.  And  when  opposite  modes  of  treatment  are 
urged  upon  the  public  by  different  practitioners 
with  reasonings  equally  specious,  it  is  not  sur- 
prising that  patients  should  sometimes  adopt 
that  which  is  least  troublesome  in  its  operation. 
Neither  is  it  surprising  that  they  should  some- 
times embrace  even  a  deception,  which  absolves 
them  from  their  allegiance  to  an  unnecessarily 
severe  or  troublesome  course  of  treatment. 

An  honest  and  independent  practitioner,  and 
especially  a  member  of  the  Massachusetts  Medi- 
cal Society,  should  never  be  induced  to  give  his 
counsel,  or  his  aid  in  any  shape,  to  empiricism 
and  dishonesty,  whether  it  occur  among  those 


REPORT   OX   HOMOEOPATHY.  Ill 

who  are  within  or  without  the  pale  of  its  mem- 
bership. And  no  consideration  of  gain  or  noto- 
riety should  induce  those,  whose  age  or  standing 
cause  them  to  be  resorted  to  for  consultation,  to 
lend  their  influence  or  countenance  to  encourage 
either  the  delusions  of  those  who  are  honest,  or 
the  practices  of  those  who  are  not. 

If  quackery,  individual  or  gregarious,  is  ever 
to  be  eradicated,  or  even  abated,  in  civilized 
society,  it  must  be  done  by  enlightening  the 
public  mind  in  regard  to  the  true  powers  of 
medicine.  The  community  must  be  made  to 
understand  that  there  are  certain  things  which 
medicine  can  do,  and  certain  other  things  which 
it  cannot  do ;  that  some  diseases  are  curable  by 
active  interference,  and  others  by  time  and  na- 
ture alone  ;  that  true  medical  skill  lies  in  discrim- 
ination and  prognosis,  and  judicious  adaptation 
of  management,  more  than  in  assumed  therapeu- 
tic power,  in  regard  to  special  agents  ;  and  that 
he  who  professes  to  cure  by  medicine  a  self- 
limited  fever  is  as  much  an  impostor,  or  deluded 
man,  as  he  who  pretends  to  do  the  same  thing 
with  a  fractured  bone  or  incised  wound.  Noth- 
ing so  much  shakes  the  confidence  of  man- 


112  REPORT   ON   HOMCEOPATHY. 

kind  in  the  medical  profession  as  unfulfilled 
promises ;  nothing  so  much  strengthens  this  con- 
fidence as  fair  dealing  exhibited  in  an  earnest 
requirement  and  fearless  expression  of  the  truth. 
Such  a  course,  by  commending  itself  to  the  sen- 
sible and  enlightened,  may  be  expected,  sooner 
or  later,  in  some  measure  to  influence  the  unrea- 
sonable and  ignorant,  —  much  sooner,  indeed, 
than  a  warfare  carried  on  in  the  arena  of  empiri- 
cism with  its  own  weapons. 


THE  MEDICAL  PKOFESSION 
AND  QUACKEKY. 


AN  INTRODUCTORY   LECTTTRE,  DELIVERED  AT  THE  MEDICAL  COLLEGE, 
BOSTON,   NOVEMBER  6,  1844. 


I  AM  about  to  address  myself  to  an  audience 
of  young  men,  a  class  of  persons  who,  in  our 
new  and  active  country,  assume  an  influence, 
and  wear  a  responsibility,  unknown  in  the  older 
communities  of  Europe.  The  sparse  character 
of  our  population,  the  call  for  active  and  efficient 
men,  the  sure  market  which  exists  for  talents, 
and  even  for  common  ability  and  prudence,  have 
given  a  national  precocity  to  our  youth,  and  a 
readiness  in  adapting  themselves  to  new  and  dif- 
ficult spheres  of  action.  I  have  heard  foreigners 
speak  with  surprise  of  the  arrival,  in  distant  ports 
10* 


114  ON   THE   MEDICAL   PROFESSION. 

of  Europe  or  India,  of  American  ships  com- 
manded, not  as  is  usual  by  weather-beaten  vet- 
erans, but  by  beardless  striplings.  The  signs  of 
our  mercantile  houses  bear  often  the  names  of 
very  young  men,  and  the  avenues  of  our  profes- 
sions are  so  crowded  with  them,  that  perhaps  no 
regulation  is  more  liable  to  be  infringed  than 
that  which  requires  that  professional  candidates 
shall  be  twenty-one  years  of  age.  Young  men 
command  the  ranks  of  our  military  corps  and 
swell  our  political  meetings.  Their  voice  is 
heard  among  us  in  the  periodical  press  and  in 
the  halls  of  legislation. 

These  precocious  habits  of  our  country  have 
of  course  been  felt  in  the  medical  profession.  In 
most  of  the  schools  of  Europe  medical  honors 
are  not  conferred  until  after  a  novitiate  of  four, 
and  more  frequently  five  years,  during  which  an 
extensive  circle  of  sciences  is  obliged  to  be  mas- 
tered, and  to  be  approved  by  a  series  of  strict 
examinations.  Not  only  are  the  essential  branches 
of  medicine  required  to  be  fully  understood,  but 
they  must  be  preceded  by  a  knowledge  of  the 
subsidiary  sciences,  and  must  also  be  confirmed 
by  practical  and  clinical  experience. 


ON   THE  MEDICAL   PROFESSION.  115 

With  us,  on  the  other  hand,  the  short  period 
of  three  preparatory  years  devoted  to  regular 
study  and  lectures  may  be  said  to  constitute 
nearly  the  sum  total  of  a  medical  education  ;  for 
the  collateral  requirements  are  so  small  that 
their  acquisition  is  often  effected  during  the 
same  three  years  which  are  applied  to  the  other 
branches.  And  a  young  man,  who  has  learned  to 
read  and  write,  issues  from  the  village  school,  or 
perhaps  from  the  counter  or  the  plough,  and  in 
three  years  is  licensed,  and  declared  competent 
to  exercise  the  multifarious  profession  of  medi- 
cine and  surgery  in  all  its  departments.  As  it 
often  happens  in  this  and  similar  cases,  the  new- 
ly-approved candidate  sends  forth  his  anxious 
glance,  directed  not  always  to  his  own  deficien- 
cies or  the  means  of  supplying  them,  but  to  that 
common  goal  and  object  of  a  young  man's  inqui- 
ry, which  is  to  fill  up  the  measure  of  his  practi- 
cal aspirations  —  an  opening.  By  the  timely 
decease  of  some  elderly  practitioner,  or  by  the 
fortunate  discovery  of  a  rising  settlement,  in 
some  distant  State,  or  on  some  promising  water- 
power,  he  finds  himself,  perhaps  at  short  notice, 
installed,  under  virtue  of  the  acquiescent  silence 


116  ON   THE  MEDICAL   PROFESSION. 

of  the  small  community  in  which  he  lives,  the 
constituted  physician  of  the  place.  In  one 
month,  perhaps  in  one  week,  he  may  be  called 
upon  to  diagnosticate  organic  lesion  in  a  case  of 
life  and  death,  or  to  treat  the  most  formidable 
convulsive  disease.  He  may  be  summoned  to  tie 
the  femoral  artery,  or  to  decide  and  act  in  a  case 
of  placental  presentation.  There  may  be  no  con- 
sulting physician  within  many  miles,  at  least  none 
who  can  arrive  in  season  for  the  emergency. 

The  safety,  then,  and  probably  the  lives  of  the 
unfortunate  constituents  of  this  young  man  will 
depend  upon  the  question  whether  he  has  or  has 
not  been  truly  educated,  whether  his  mind  and 
hand  have  been  adequately  trained  for  the  great 
occasions  that  await  him.  It  is  not  enough  that 
he  has  suffered  three  years  to  expire  while  tak- 
ing his  ease  in  the  office  of  a  city  physician,  nor 
that  he  has  passed  a  corresponding  time  in  fol- 
lowing the  rounds  of  a  country  practitioner.  It 
is  not  enough  that  he  has  carelessly  read  the 
works  of  approved  authors,  and  has  squeezed 
through  the  customary  academic  examination. 
If  he  has  done  only  this,  it  is  more  than  probable 
that  failure  awaits  on  himself  and  disaster  upon 


ON  THE   MEDICAL   PROFESSION.  117 

his  patient.  But  if  his  studies  have  been  method- 
ical, and  conducted  with  an  eye  to  practical  ap- 
plication ;  if  he  has  concentrated  his  attention 
upon  necessary  points  ;  if  he  has  felt  the  earnest 
interest  which,  more  than  anything  else,  imprints 
truth  on  the  remembrance  ;  if  he  has  gathered 
up  and  arranged  his  resources  in  reference  to 
coming  emergencies  ;  if  he  has  gone  over  in  an- 
ticipation the  difficulties  of  his  profession,  and 
planned  his  own  mode  of  extrication,  —  then  he 
will  find  that  inexperience  does  not  involve  fail- 
ure, and  that  youth  is  not  an  insurmountable  bar- 
rier to  success.  He  will  recollect  that  the  most 
eminent  physicians  and  the  most  successful  oper- 
ators have  had  their  first  cases.  He  will  per- 
haps also  remember  that  some  of  the  most  dis- 
tinguished men  in  history  have  emerged  from 
obscurity  while  yet  in  youth ;  that  not  only  war- 
riors, like  Alexander  and  Napoleon,  but  states- 
men, like  Pitt  and  Fox,  and  philosophers,  like 
Davy  and  Bichat,  had  achieved  some  of  their 
proudest  laurels  at  the  very  entrance  of  man- 
hood. 

Let  it  not  be  supposed,  however,  that  I  am  an 
advocate  for  the  premature  assumption,  by  young 


118  ON  THE   MEDICAL   PROFESSION. 

men,  of  the  responsibilities  of  our  profession. 
Every  medical  student  is  to  be  considered  unfor- 
tunate, who,  by  reason  of  poverty,  or  the  stress 
of  other  circumstances,  is  obliged  to  hurry  his 
probationary  period  to  an  early  termination.  Too 
much  time  and  attention  are  not  often  bestowed 
on  the  business  of  preparation  for  practice.  The 
oldest  and  the  best  physicians  have  had  frequent 
cause  to  regret  that  they  were  not  better  edu- 
cated. But  the  superficial  student,  who  rarely 
has  the  time  and  the  will  to  repair  his  early  defi- 
ciencies, is  haunted  through  life  by  a  round  of 
perplexity  and  embarrassment,  and  degraded  by 
a  sense  of  his  own  incompetency. 

It  should  be  borne  in  mind  that  there  is  no 
period  of  life  in  which  time  can  be  so  conven- 
iently spared  from  lucrative  pursuits  as  in  youth. 
After  a  man  has  attained  to  the  age  of  thirty,  it 
is  commonly  of  very  little  consequence  to  him, 
as  far  as  his  fame  and  yearly  receipts  are  con- 
cerned, whether  he  had  commenced  practice  at 
the  age  of  twenty-one  or  of  twenty-four.  But  as 
far  as  he  may  prize  a  quiet  conscience  and  free- 
dom from  anxiety,  the  later  age  is  incomparably 
the  most  secure.  I  would  advise  any  young 


ON  THE   MEDICAL   PEOFESSION.  119 

man,  who  has  completed  his  education  at  the  end 
of  his  minority,  that  he  should  devote  two  addi- 
tional years,  and,  if  practicable,  a  still  longer 
period,  to  availing  himself  of  such  advantages, 
both  in  study  and  practice,  as  may  prepare  him 
for  his  future  duties.  And  when,  as  it  often  hap- 
pens in  our  community,  narrow  circumstances 
require  that  a  young  man  should  live  by  his  own 
exertions,  this  state  of  things,  instead  of  being  a 
motive  that  he  should  crowd  himself  prematurely 
into  the  ranks  of  the  profession,  encumbered 
with  debt,  and  bare  of  acquirements  and  of 
means,  is  rather  an  imperative  reason  that  he 
should  at  once  begin  by  resolving  to  devote 
twice  the  customary  number  of  years,  if  neces- 
sary, to  the  double  purpose  of  keeping  himself 
in  an  independent  position,  and  of  placing  him- 
self at  length,  in  point  of  maturity  of  knowledge, 
on  a  par  with  his  more  favored  competitors. 

It  may  not  be  improper,  in  this  place,  to  offer 
you  some  suggestions  as  to  the  mode  in  which 
students  may  advantageously  appropriate  the 
time  of  their  pupilage  in  reference  to  the  science 
which  they  expect  to  acquire.  Medical  literature 
has  become  so  vast  a  subject,  that  the  undirected 


120  ON  THE   MEDICAL   PROFESSION. 

student  is  apt  to  be  lost  in  the  maze  of  books  and 
sciences  which  seem  equally  to  press  upon  his 
attention.  And  he  is  likely  to  fall  into  the  per- 
nicious error  of  thinking  that  he  must  read  a 
great  deal,  even  though  he  remembers  little. 
The  true  object  of  a  medical  pupilage  should  be, 
not  to  read,  but  to  study,  to  observe,  and  to 
remember ;  not  to  pass  superficially  over  the 
writings  of  celebrated  men,  but  to  select  those 
compendiums  of  the  several  sciences,  which  con- 
tain a  condensed  view  of  their  essential  and  ele- 
mentary facts,  which  separate  the  wheat  from  the 
chaff,  and  offer  what  is  fundamental  and  useful, 
within  a  compass  which  is  capable  of  being  im- 
pressed on  the  memory.  Most  of  the  constitu- 
ent sciences  which  are  nominally  included  in  a 
modern  medical  education,  are  now  so  extensive, 
that  the  cultivation  of  any  one  of  them  may  af- 
ford abundant  occupation  for  a  common  lifetime. 
Passing  over  the  more  elementary  branches,  I 
may  instance  the  theory  and  practice  of  medi- 
cine, the  literature  of  which  is  a  vast  magazine 
of  rubbish,  with  a  few  gems  imbedded  in  it,  accu- 
mulated in  all  time  since  the  origin  of  writing, 
and  in  such  excess  that  no  country  in  Europe 


ON  THE  MEDICAL  PROFESSION.  121 

could  probably  furnish  even  a  catalogue  of  its 
own  modern  books.  The  history  of  this  exten- 
sive science  contains  a  mixture  of  much  that  is 
bad  with  much  less  that  is  good.  And  although 
in  medical  research  the  still  small  voice  of  truth 
has  from  time  to  time  made  itself  heard  for  a 
season,  yet  it  has  as  often  been  drowned  by  the 
dogmas  of  the  visionary  and  the  clamors  of  the 
interested.  During  the  present  century  a  host 
of  theorists  and  gratuitous  reformers  have  re- 
placed each  other  on  the  arena  of  medical  con- 
troversy. But  we  have  seen  that  while  a  truth 
in  medical  science,  like  the  import  of  the  physical 
signs  for  example,  struggles  its  way  through  op- 
position and  distrust  into  general  adoption,  —  an 
unfair  and  unfounded  assumption  rarely  survives 
long  the  life  of  the  individual  whose  own  elo- 
quence and  obstinacy  were  necessary  to  force  it 
for  a  time  upon  the  public  attention. 

If  we  could  purge  the  sciences  of  pathology 
and  therapeutics  from  the  writings  of  men  who 
wrote  merely  because  they  had  a  reputation  to 
acquire  or  a  doctrine  to  establish ;  and  could 
confine  these  sciences  to  the  results  attained  by 
those  who  sought  directly  and  impartially  for  the 
11 


122  OX  THE  MEDICAL  PROFESSION. 

true  and  the  useful ;  it  is  probable  that  the  whole 
subject  would  be  brought  within  the  comprehen- 
sion, not  only  of  every  physician,  but  of  every 
medical  student.  And  from  the  recent  mode  of 
conducting  medical  investigations,  which  has  com- 
menced and  is  gradually  gaining  foothold  in  all 
civilized  countries,  we  may  hope,  in  our  own  day, 
to  see  near  approaches  to  this  desirable  result. 

Every  medical  man,  whether  student  or  phy- 
sician, owes  a  threefold  duty,  to  himself,  to  his 
competitors,  and  to  his  patients.  To  himself  he 
owes  the  cultivation  of  habits  of  order  and  per- 
severance, a  love  of  honesty,  and  a  desire  of 
knowledge.  Xo  man  is  successful  in  a  learned 
profession  who  does  not  cultivate  a  methodical 
disposition  of  his  time.  The  neglect  of  an  hour, 
the  omission  of  an  engagement,  and  the  post- 
ponement of  what  is  necessary  for  what  is  unim- 
portant, have  ruined  many  a  good  intention  and 
many  a  promising  prospect.  Lord  Chesterfield 
says  that  the  Duke  of  Newcastle  lost  half  an 
hour  in  the  morning,  and  spent  the  whole  day  in 
running  after  it.  This  is  a  true  expression  of 
the  career  of  a  busy  but  inefficient  man.  He 
who  is  always  driven,  always  in  a  hurry,  always 


ON  THE  MEDICAL   PKOFESSION.  123 

late,  and  always  with  deficiencies  to  be  made  up, 
is  very  likely  to  be  always  a  failure.  It  is  well 
known  that  the  responsibilities  of  society  are 
best  and  most  easily  discharged  by  those  who 
estimate  the  value  of  small  portions  of  time,  who 
do  things  strictly  in  their  proper  season  and 
place,  who  provide  against  contingencies,  and 
distribute  their  day  in  reference  to  what  is,  as 
well  as  to  what  may  be,  required  of  them. 

But  the  best  ordered  arrangement  of  time, 
and  the  most  punctual  habits  of  attention,  do 
not  always  succeed  in  our  profession,  except 
through  perseverance,  and  often  through  long 
suffering.  The  public,  especially  in  cities,  are 
slow  in  giving  their  confidence  to  strangers  and 
to  young  men.  The  late  Dr.  Physick,  of  Phila- 
delphia, asserted  that  during  the  first  three  years 
of  his  practice  he  did  not  pay  for  his  shoe- 
leather  ;  and  a  late  very  eminent  physician  of 
this  city  once  informed  me  that  he  did  not  earn 
his  own  board  during  three  times  that  period. 
The  conservative  principle  which  retards  the 
reception  of  young  men  into  lucrative  business, 
is  the  foundation  of  their  security  in  after  life, 
for  medical  practice  would  not  be  worth  having, 


124  ON   THE  MEDICAL   PROFESSION. 

in  a  community  whose  love  of  change  should 
lead  them  to  desert  their  former  friends  and 
counsellors,  to  run  after  every  new-comer.  Phy- 
sicians usually  come  on  to  the  stage  and  move 
off  of  it  in  company  with  the  generation  to 
which  they  belong.  In  a  large  city,  a  young 
physician,  except  under  circumstances  of  pecu- 
liar patronage  or  necessity,  does  not  usually 
obtain  employment  from  families  who  are  much 
in  advance  of  himself.  But  these  families  and 
their  medical  attendants  pass  away,  and  he  and 
his  cotemporaries  become  the  standing  practi- 
tioners of  their  time.-  A  preparatory  period  in 
the  meantime  elapses,  during  which  the  candi- 
date for  future  honors  has  usually  enough  to  do 
to  perfect  his  knowledge,  to  fill  the  gaps  in  his 
experience,  and  to  give  proofs  to  the  community 
around  him  that  he  possesses  aptitude  for  the 
common  affairs  of  life. 

Every  physician  is  an  inquirer  during  life,  and 
continues  to  learn  something  up  to  the  last  year 
in  which  he  may  happen  to  study  or  practise. 
As  the  science  advances,  moreover,  every  intel- 
ligent practitioner  is  obliged  to  replace  some  of 
his  former  opinions  with  others  which  he  finds 


ON  THE   MEDICAL   PROFESSION.  125 

to  be  better  substantiated.  We  should  be  care- 
ful, therefore,  not  to  pledge  ourselves  unneces- 
sarily to  medical  opinions  which  are  founded  on 
equivocal  or  imperfect  testimony.  The  public 
sentiment  attaches  a  kind  of  disgrace  to  frequent 
changes  and  recantations,  and  it  ought  also  to 
do  the  same  to  the  course  of  any  man  who,  for 
the  sake  of  consistency  with  himself,  continues 
to  maintain  an  erroneous  and  exploded  opinion. 
Both  these  extremes  are  avoided  by  the  physi- 
cian who  reserves  his  assent  to  any  new  opinion 
until  the  evidence  of  the  case  is  satisfactorily 
made  out. 

One  of  the  most  difficult  virtues  for  a  physi- 
cian to  cultivate  is  a  just  and  proper  deportment 
towards  his  professional  brethren.  As  in  all 
professions  in  which  men  live  by  their  heads 
rather  than  their  hands,  business  is  liable  to  be 
overdone,  and  a  candidate  who  has  not  acquired 
all  the  occupation  that  he  wishes,  is  apt  to 
regard  his  competitors  as  stumbling-blocks,  to  be 
gotten  rid  of  by  fair  means  or  foul.  Hence  arise 
the  jealousies,  calumnies,  and  open  hostilities  so 
often  entertained,  which  injure  all  the  parties 
concerned,  and  lower  the  estimation  of  the  pro- 
11* 


126  ON  THE   MEDICAL   PROFESSION. 

fession  with  the  public.  Harmony  and  a  proper 
esprit  du  corps  may  uphold  the  dignity  of  even 
an  inferior  profession ;  but  the  public  rarely  re- 
spect any  class  of  men,  the  members  of  which 
have  no  respect  for  each  other.  A  friendly  inter- 
course with  those  whom  we  approve  is  produc- 
tive of  pleasure  and  advantage,  and  a  gentlemanly 
forbearance  towards  those  with  whom  we  do  not 
agree  will  show  that  we  are  above  jealousy.  A 
man  is  always  to  be  suspected,  who  tells  you  that 
he  is  surrounded  with  enemies ;  and  one  who  is 
an  habitual  calumniator  of  others  forces  upon 
his  hearers  the  conviction  that  they  hi  their 
proper  turn  are  to  come  in  for  their  share  of  his 
animadversions. 

I  doubt  if  physicians  do  not  sometimes  injure 
themselves  and  their  cause  by  showing  too  great 
a  sensitiveness  in  regard  to  the  temporary  inroads 
of  irregular  practitioners.  Quackery,  whether  car- 
ried on  by  the  audacious  enterprise  of  an  individ- 
ual impostor,  or  upheld  by  the  trumpeting  of  a 
fanatical  sect,  is  to  be  considered  a  necessary 
evil  inherent  in  the  constitution  of  society.  It 
exists  in  every  walk  and  occupation  of  life  by 
the  exercise  of  which  men  procure  bread.  The 


QUACKERY.  127 

pettifogger  in  law,  the  Millerite  lecturer  in  theol- 
ogy, the  demagogue  in  politics,  the  system-mong- 
er in  education,  and  the  wonder-worker  upon  the 
brains  and  bowels  of  infatuated  audiences, — what 
are  all  these  but  quacks  moving  in  their  respect- 
ive spheres,  and  fattening  upon  the  credulity  of 
dupes  ?  A  certain  portion  of  mankind  are  so  con- 
stituted that  they  require  to  be  ridden  by  others, 
arid  if  you  should  succeed  in  unhorsing  a  particu- 
lar impostor,  it  is  only  to  prepare  the  saddle  for 
a  fresh  and  more  unflinching  equestrian.  It  is 
not  good  policy  to  say  or  to  write  too  much  in 
regard  to  the  pretensions  of  impostors.  A  cele- 
brated author  observes  that  "many  a  popular 
error  has  flourished  through  the  opposition  of 
the  learned.'7*  By  throwing  the  gauntlet  at  an 
insignificant  man,  you  at  once  raise  him  to  the 
dignity  of  being  your  competitor,  and  acknowl- 
edge him  as  a  "  foeman  worthy  of  your  steel." 
And  if  you  discover  uneasiness,  resentment,  or 
ill-temper,  the  public  conclude  that  you  are  influ- 
enced by  your  private  interests.  Besides,  when 
you  have  entered  the  arena  of  controversy,  you 
will  probably  find  that  the  quack,  who  has  his  all 

*  Macintosh. 


128  QUACKERY. 

at  stake,  can  afford  more  breath  and  time  than 
you  can  conveniently  spare  from  your  other 
occupations,  and  in  an  active  warfare,  he  may  ac- 
quire two  partisans  to  your  one.  It  is  not  long 
since  the  exhibiter  of  a  stuffed  mermaid  suc- 
ceeded in  drawing  down  the  popular  indignation 
on  an  unfortunate  naturalist,  who  had  ventured  to 
declare  that  it  was  made  of  a  fish  and  a  monkey. 
The  public  generally  require  time  to  get  disa- 
bused of  a  favorite  error ;  and,  if  too  abruptly 
assailed,  they  will  sometimes  hold  on  to  it,  as  the 
traveller  did  to  his  cloak  when  attacked  by  the 
north  wind. 

In  your  demeanor  in  regard  to  quacks,  you 
should  keep  aloof  from  them,  and  trouble  your- 
selves little  about  them.  Admit  the  general  fact, 
that  the  race  always  do  and  must  exist  in  socie- 
ty ;  that  they  are  wanted  by  the  credulity  of  a 
particular  class  of  minds ;  that  the  fall  of  one 
dishonest  pretender,  or  one  visionary  sect,  is  sure 
to  be  replaced  by  the  elevation  of  another ;  there- 
fore it  little  concerns  you  to  know  what  particu- 
lar imposition  has  the  ascendency  at  any  given 
time.  When  you  are  interrogated  in  regard  to  a 
specific  subject  of  this  kind,  you  should  make  a 


QUACKERY.  129 

reasonable,  cogent  and  dispassionate  answer,  al- 
ways avoiding  the  appearance  of  warmth,  and 
especially  of  self-interest ;  and  you  may  be  sure 
that  a  majority  of  the  public  will  be  on  the  side 
of  truth.  As  far  as  my  observation  extends,  three 
quarters  at  least  of  the  families  in  Boston  and 
New  England  are  in  the  hands  of  regular  practi- 
tioners. The  remaining  fraction,  more  or  less, 
consists  partly  of  minds  so  constituted  that  they 
require  the  marvellous  as  a  portion  of  their  neces- 
sary food,  and  partly  of  unfortunate  beings,  suf- 
fering the  inevitable  lot  of  humanity,  who,  having 
failed  to  obtain  relief  from  the  ordinary  resources 
of  medicine,  seek  for  temporary  encouragement 
in  the  dishonest  assurances  of  any  who  will 
promise  to  cure  them.  The  first  class  is  the  dog 
in  the  fable,  catching. at  shadows  ;  the  last  is  the 
drowning  man,  catching  at  straws. 

Above  all,  if  you  would  discountenance  quack- 
ery, take  care  that  you  become  not  quacks  your- 
selves. Charlatanism  consists  not  so  much  in 
ignorance,  as  in  dishonesty  and  deception.  In 
your  intercourse  with  patients,  cultivate  a  spirit 
of  fidelity,  candor  and  truth.  Endeavor  to  under- 
stand yourselves  and  your  science,  weigh  justly 


130  QUACKERY. 

your  own  powers,  and  profess  only  what  yon  can 
accomplish.  If  yon  annonnce  to  yonr  patients 
that  yon  will  cnre  incnrable  diseases,  or  cut  short 
those  which  have  a  necessary  period  of  duration, 
you  do  not  speak  the  truth ;  you  merely  blind 
your  patient,  while  you  throw  the  die  for  a  for- 
tuitous result,  a  game  at  which  the  veriest  moun- 
tebank may  at  any  time  beat  you.  The  profes- 
sion as  a  body  are  often  unpopular  with  a  large 
and  sagacious  part  of  the  community,  because 
they  so  frequently  disappoint  the  expectations 
they  have  allowed  themselves  to  raise.  You  may 
safely  undertake  and  promise  to  cure  diseases 
which  you  know  to  be  curable,  to  alleviate  others 
which  you  know  to  be  not  so,  and  to  perform 
what  art  and  science  can  do  towards  conducting 
doubtful  and  dangerous  cases  to  a  happy  issue. 
But  this  is  all  you  can  accomplish  or  promise. 
The  skilful  mariner  may  steer  his  ship  through  a 
dangerous  navigation,  but  he  cannot  control  the 
wind  nor  arrest  the  storm.  Nor  would  he  gain 
reputation  by  professing  to  do  so. 

It  is  hardly  necessary  that  I  should  counsel 
you  not  to  neglect  your  patients,  when  you  can 
do  anything  for  their  welfare  and  security.  Xeg- 


ON   THE  MEDICAL   PBOFESSION.  131 

lect  of  outward  attentions  is  not,  I  think,  a  very 
frequent  sin  of  physicians,  inasmuch  as  their 
interest  very  obviously  lies  in  a  different  course. 
But  many  practitioners  fall  into  the  opposite 
error  of  over-attention  to  their  patients,  of  mak- 
ing them  long,  tedious  or  superfluous  visits,  of 
hampering  them  with  strict  and  complicated  in- 
structions, and  especially  of  over-drugging  them 
with  remedies.  There  are  some  patients,  it  is 
true,  who  like  to  be  bled,  blistered  and  physicked; 
but  the  number  is  small,  and  in  most  cases  both 
the  instinct  of  the  child,  and  the  discretion  of  the 
grown  man,  cause  them  to  revolt  against  nauseous 
and  painful  inflictions.  When,  therefore,  you  are 
called  to  take  charge  of  a  case,  ask  yourselves 
how  great  is  the  danger,  and  what  is.  the  probable 
tendency  of  the  disease,  if  left  to  itself.  If  life  is 
in  question,  and  you  have  reason  to  believe  that 
the  patient  may  be  rescued  by  prompt  and  ener- 
getic remedies,  you  should  not  hesitate  to  employ 
them.  But  in  common,  trivial  and  safe  cases,  such 
as  afford  a  large  part  of  a  physician's  occupation, 
you  should  not  allow  a  habit,  or  a  hobby,  to  lead 
you  into  the  blind  routine  of  always  thinking  that 
you  must  make  your  patients  worse  before  they 


132  ON  THE  MEDICAL  PROFESSION. 

can  be  better.  I  believe  that  much  of  the  medi- 
cal imposition  of  the  present  day  is  sustained  in 
places  where  practice  has  previously  been  over- 
heroic,  and  because  mankind  are  gratified  to  find 
that  they  and  their  families  can  get  well  without 
the  lancet,  the  vomit  and  the  blister,  indiscrimi- 
nately applied  ;  and  because  the  adroit  charlatan 
transfers  the  salutary  influences  of  time  and  na- 
ture to  the  credit  of  his  own  less  disagreeable 
inflictions. 

It  is  the  duty  of  physicians  to  elevate  their 
profession,  by  maintaining  in  their  individual 
character  a  high  moral  rectitude,  a  just  and  hon- 
orable conduct,  a  devotedness  to  the  welfare  of 
their  patients,  and  an  unceasing  effort  to  improve 
themselves  and  their  science.  If  this  course  is 
pursued  by  medical  men,  they  can  hardly  fail  of 
becoming  useful  and  respected  members  of  soci- 
ety. There  is  no  country  in  the  world  in  which 
the  avenues  to  respectability  and  distinction,  to 
competency,  and  even  to  wealth,  are  more  open 
to  physicians,  than  in  the  United  States.  It  has 
been  observed  that  in  England  no  medical  man 
is  ever  permitted  to  attain  the  aristocratic  rank, 
which  belongs  to  birth,  and  which  is  occasionally 


ON  THE  MEDICAL   PKOFESSION.  133 

accorded  to  eminence  in  the  military,  political, 
legal  and  financial  professions.  But  in  our  coun- 
try there  is  no  post  of  honor  or  emolument,  and 
no  situation  of  influence  and  distinction,  which 
our  history  does  not  show  to  be  within  the  reach 
of  our  profession.  But  it  is  not  to  political  or 
extra-professional  preferment  that  the  true  phy- 
sician should  look.  He  should  rather  be  con- 
tented to  build  up  his  own  character  within  his 
own  sphere,  as  a  man  of  knowledge,  fidelity  and 
honor.  The  respect  of  the  community,  and  the 
attachment  of  friends,  will  always  attend  on  him 
who  loves  truth  for  its  own  sake,  pursues  knowl- 
edge that  he  may  be  able  to  benefit  others,  and 
deals  justly  with  his  fellow-men,  consenting  that 
they,  in  turn,  should  deal  justly  with  him. 
12 


ON 


GOUT  AND  ITS  TREATMENT 


GOUT,  technically  known  by  the  names  of  Ar- 
thritis and  Podagra,  is  a  painful,  inflammatory 
disease,  appearing  by  paroxysms,  affecting  chiefly 
the  smaller  joints,  but  liable  to  change  its  seat  to 
various  more  important  organs.  It  is  hereditary 
in  its  character,  and  affects  the  luxurious  more 
than  the  laboring  and  abstemious  classes.  It  sel- 
dom occurs  in  children,  but  makes  its  appearance 
most  commonly,  in  middle  or  advanced  life,  and 
affects  men  more  frequently  than  women. 

The  most  common  place  for  the  primary  attack 
of  gout  is  in  the  first  joint,  or  ball,  of  the  great 
toe  of  one  foot.  The  patient,  in  many  cases  with- 
out previous  indications  of  illness,  is  surprised 
at  being  awakened  in  the  middle  of  the  night,  or 
a  little  later,  by  intolerable  pain  in  that  joint, 


ON   GOUT.  135 

with  much  febrile  heat  and  restlessness,  com- 
mencing, perhaps,  in  a  slight  chill.  The  toe-joint 
soon  becomes  swollen,  tense  and  red.  Some- 
times the  ankle,  heel,  or  instep  is  similarly  af- 
fected. There  is  exquisite  tenderness  on  the 
slightest  pressure  or  motion  of  the  part.  This 
state  of  things  continues  from  six  to  twenty-four 
hours,  after  which  a  remission  of  pain  takes 
place,  with  gentle  perspiration,  and  tendency  to 
sleep.  The  inflamed  joint,  however,  continues 
to  increase  in  swelling,  and  at  length  becomes 
cedematous  and  shining.  On  the  following  night 
the  pain  and  fever  return,  and  so  continue  to  do 
for  a  week,  more  or  less,  during  which  there  is 
thirst,  want  of  appetite,  costiveness,  and  scanty 
high-colored  urine  depositing  a  red  or  lateritious 
sediment  on  cooling. 

The  paroxysm  lasts  ordinarily  from  three  to 
ten  days,  at  the  end 'of  which  time  the  pain  sud- 
denly terminates,  as  if  by  magic.  The  joint  con- 
tinues swollen  and  oedematous  for  a  few  days, 
with  itching  and  exfoliation  of  the  cuticle,  but 
the  patient  returns  to  his  accustomed  health 
with  perhaps  an  unwonted  degree  of  vigor  and 
alacrity. 


136  ON  GOUT. 

A  precursory  stage  in  most  persons  takes  place 
in  advance  of  the  paroxysm.  It  is  marked  by  a 
deranged  state  of  the  appetite  and  digestion,  by 
heartburn,  nausea,  flatulence,  and  offensive  alvine 
discharges,  also  by  languor,  headache,  low  spirits 
and  disturbed  sleep. 

The  first  paroxysm  of  gout  is  the  almost  cer- 
tain prelude  to  others,  which  are  to  follow  after 
an  interval  of  some  months  or  years,  according 
to  the  predisposition  and  habits  of  life  of  the 
patient.  Some  persons  escape  with  two  or  three 
paroxysms  only  during  life ;  others  have  an  an- 
nual visitation,  and  others  are  attacked  once  in 
two  or  three  months.  The  frequency  of  the  par- 
oxysms goes  on  increasing,  until  in  some  patients 
there  is  hardly  any  respite,  unless  for  a  few 
months  in  summer.  The  later  paroxysms,  how- 
ever, are  often  more  supportable,  but  the  gen- 
eral health  is  more  impaired  than  in  the  earlier 
attacks. 

In  the  later  attacks  both  feet  are  liable  to  be 
affected  in  succession,  and  the  inflammation,  after 
having  left  one  foot,  may  return  to  it  again.  The 
small  joints  of  the  hand  are  also  subject  to  the 
invasion,  constituting  the  variety  of  gout  called 


ON  GOUT.  137 

chlragra.  In  inveterate  cases  there  is  scarcely 
any  joint  of  the  body  which  may  not  participate 
in  the  extension  of  the  disease.  Effusion  gener- 
ally takes  place  into  the  synovial  cavities  and 
adjacent  cellular  tissues. 

When  the  disease  has  become  thus  confirmed 
it  is  usually  called  chronic  gout.  This  commonly 
follows  the  acute  form,  but  in  some  cases  may 
become  gradually  established  without  it.  In 
chronic  gout  the  affected  limbs  are  disabled  for 
exercise,  they  become  painful  at  night,  interrupt- 
ing sleep,  and  are  moved  by  the  patient  with 
difficulty  and  caution.  There  is  also  a  general 
deterioration  in  the  strength  and  spirits,  the  pa- 
tient looks  worn,  sallow  and  haggard,  the  diges- 
tive powers  are  deranged,  and  there  is  often 
palpitation  and  dyspnoea. 

When  the  disease  has  existed  for  a  certain 
length  of  time,  there  appears  in  some  persons, 
but  not.  in  all,  a  deposit  of  calcareous  concre- 
tions, known  by  the  name  of  chalk-stones,  situated 
mostly  in  the  cellular  tissue,  between  the  outside 
of  the  joint  and  the  skin.  Sometimes,  however, 
they  penetrate  the  fibrous  textures  and  the  cavi- 
ties of  the  joints.  These  concretions  are  fluid, 


138  ON  GOUT. 

or  semifluid,  when  first  effused,  but  become  grad- 
ually solid  by  the  absorption  of  their  fluid  parts. 
They  finally  become  hard  and  friable,  resembling 
common  chalk  in  their  appearance.  In  their 
more  fluid  state  they  are  formed  of  hydrated 
lithate  of  soda,  but  the  solid  concretions  consist 
mainly  of  lithate  of  soda,  with  some  phosphate 
of  lime. 

The  chalky  concretions  are  liable  to  grow  with 
the  return  of  every  paroxysm.  In  bad  cases  the 
skin  finally  gives  way,  and  a  chalky  serous  fluid 
is  discharged.  This  is  afterwards  replaced  by  a 
kind  of  chalky  pus,  and  in  this  manner  a  part  of 
the  chalk  escapes,  but  never  the  whole,  owing  to 
its  entanglement  in  the  cells  and  textures.  Per- 
sons have  been  known  to  write  their  names  with 
the  denuded  chalk  protruding  from  the  knuckles. 
Sometimes  the  apertures  close  over  and  cicatrize, 
but  are  liable  to  break  out  again  during  subse- 
quent paroxysms.  Chalk-stones  are  most  com- 
mon in  the  joints  of  the  hands  and  feet,  which 
they  distort  in  an  unsightly  manner.  They  may, 
however,  appear  in  any  part  which  happens  to  be 
the  seat  of  gouty  inflammation. 

Persons  who  are  subjects  of  gout  are  also  Ha- 


ON  GOUT.  139 

ble  to  gravelly  complaints,  and  to  calculus  both 
of  the  kidneys  and  bladder.  The  urine  is  found 
not  only  to  contain  urea  and  the  other  solids  in 
excess,  but  deposits  lithic  acid  and  lithate  of 
soda.  The  nephritic  complaints  generally  super- 
vene after  the  gout  has  lasted  some  time,  and  the 
paroxysms  of  the  two  complaints  rather  alternate 
than  coincide  with  each  other. 

In  regard  to  the  causes  of  gout,  it  is,  in  the 
first  place,  an  hereditary  disease.  A  majority  of 
persons  affected  with  it  can  trace  the  predisposi- 
tion to  their  parents  or  ancestry.  It  does  not 
follow,  however,  that  all  the  children  of  gouty 
progenitors  have  the  disease.  It  sometimes  leaps 
over  one  generation  and  appears  in  the  next,  and 
it  is  frequently  kept  off,  in  those  who  are  disposed 
to  it,  by  an  active  and  abstemious  life.  When 
gout  and  gravel  affect  the  same  person,  it  often 
happens  that  some  of  the  childreri  inherit  the 
one,  and  some  the  other  disease,  alone. 

Gout  rarely  if  ever  appears  before  puberty. 
In  the  statistical  accounts  collected  by  Sir  C. 
Scudamore,  it  appears  that  the  greatest  number 
of  first  attacks  came  on  between  the  ages  of 
thirty  and  forty.  But,  although  the  number 


140  ON  GOUT. 

which  began  in  persons  above  forty  was  some- 
what smaller,  it  is  evident  that,  if  averaged  npon 
the  whole  number  of  persons  actually  living, 
above  that  age,  the  proportion  would  be  greater. 

Gout  occurs  more  frequently  in  men  than  in 
the  female  sex.  Yet  women  are  by  no  means 
exempt  from  it,  and  in  them  it  is  most  apt  to 
appear  after  the  cessation  of  the  catamenia. 
The  stout  and  corpulent,  of  both  sexes,  are 
more  liable  to  it  than  those  of  the  opposite 
conformation. 

The  cause  which  is  undoubtedly  most  active 
in  the  production  of  gout  is  a  luxurious  life,  with 
the  free  use  of  vinous  liquors.  Persons  who  take 
little  exercise,  and  indulge  largely  in  the  pleas- 
ures of  the  table,  especially  in  animal  food  and 
fermented  drinks,  are  the  most  common  subjects 
of  the  disease.  Among  persons  who  are  addicted 
to  the  excessive  use  of  alcoholic  liquids,  it  is 
observed  that  gout  occurs  much  more  frequently 
in  those  who  consume  wine  and  malt  liquors, 
than  in  those  who  are  intemperate  in  distilled 
spirits.  The  disease  is  more  common  in  England 
than  in  this  country,  and  occurs  much  more  fre- 


ON  GOUT.  141 

i 

quently  among  the  wealthy  and  luxurious,  than 
among  the  poorer  and  laborious  classes. 

There  are  various  exceptional  forms,  under 
which  the  gouty  diathesis  may  become  apparent 
in  the  system.  Sometimes  the  viscera  become 
deranged,  without  obvious  affection  of  the  joints, 
constituting  irregular  or  concealed  gout.  Thus 
the  digestive  tube  may  be  affected  with  nausea, 
want  of  appetite,  pain,  flatulence,  costiveness,  or 
diarrhoea,  acid  eructations,  and  even  vomiting. 
In  the  thorax  are  sometimes  felt  pain,  dyspnoea 
and  palpitation,  and  in  the  head,  vertigo,  diminu- 
tion of  sight  and  hearing,  with  headache,  and 
sometimes  numbness  and  lethargic  heaviness. 
The  spirits  are  excessively  dejected,  and  the 
mind  peevish  and  irritable.  Sometimes  the  gouty 
inflammation  attacks  the  eye,  the  fauces,  or  the 
urethra,  producing  symptoms  imitative  of  various 
diseases. 

The  name  of  retrocedent  gout  is  applied,  when 
the  disease,  by  a  sudden  metastasis,  disappears  at 
once  from  an  inflamed  joint,  and  attacks  some 
internal  organ  with  violent  and  alarming  symp- 
toms. The  part  most  commonly  seized  is  the 
stomach,  in  which  there  is  sudden  pain,  with 


142  ON   GOUT. 

perhaps  nausea  and  vomiting,  and  great  anxiety 
and  distress.  The  heart  may  also  be  attacked 
with  syncope  and  urgent  dyspnoea,  or  the  brain 
with  symptoms  of  apoplexy  and  paralysis. 

The  prognosis  of  gout  is  not  unfavorable  in 
the  early  stages,  and  so  long  as  it  keeps  to  the 
extremities.  But  the  retrocession  of  the  disease 
to  the  stomach,  the  heart,  or  to  the  brain  and  its 
membranes,  is  fraught  with  considerable  danger. 
The  prevalent  notion  that  gout  secures  an  immu- 
nity from  other  diseases  is  now  generally  admit- 
ted to  be  founded  in  error.  All  that  can  be  said 
to  be  true  is  that  many  anomalous  symptoms, 
both  local  and  constitutional,  which  depend  on 
concealed  or  atonic  gout,  and  which  may  have 
harassed  the  patient  for  a  long  time,  suddenly 
give  way  when  the  gout  declares  itself  in  the 
form  of  a  regular  paroxysm  in  the  foot. 

In  its  diagnosis  gout  is  principally  liable  to  be 
confounded  with  rheumatism.  The  following  cir- 
cumstances will  serve  to  distinguish  them.  Gout 
affects  the  small  joints,  principally  of  the  great 
toe.  •  Acute  rheumatism  attacks  chiefly  the  large 
ones,  and  often  many  at  a  time.  In  gout  the 
inflamed  joint  is  of  a  vivid  red  color,  it  after- 


ON  GOUT.  143 

wards  becomes  oedematous,  and  ends  with  peel- 
ing off  of  the  cuticle.  In  rheumatism  the  joints 
are  less  red,  and  the  cuticle  does  not  desquamate. 
Gout  is  more  paroxysmal  in  its  character,  and 
alternates  with  intervals  of  ease  more  than  rheu- 
matism. The  chalky  deposits  are  characteristic 
of  gout,  the  acid  perspirations  of  rheumatism. 
Gout  is  hereditary,  affects  the  luxurious  and  in- 
dolent, and  appears  after  puberty.  Rheumatism 
is  less  distinctly  hereditary,  and  may  affect  per- 
sons of  all  ages,  classes  and  occupations. 

The  above  diagnostic  marks  appear  to  me  to 
constitute  a  legitimate  distinction  between  the 
diseases  of  gout  and  rheumatism.  It  is  but  just, 
however,  to  state  that  these  distinctive  charac- 
ters are  liable  to  numerous  exceptions,  and  that 
some  of  the  best  French  pathologists,  such  as 
Chomel,  Grisolle  and  Requin,  deny  the  diversity 
of  the  two  diseases.  And  experienced  physicians 
are  sometimes  at  a  loss  to  which  of  these  forms 
of  disease  they  shall  assign  particular  cases  which 
exhibit  the  characteristics  of  both. 

The  treatment  of  a  first  paroxysm  of  gout  may 
be  expectant  and  palliative,  for  it  is  not  certain 
how  soon  spontaneous  resolution  will  arrive,  and 


144  ON  GOUT. 

the  patient,  not  without  reason,  is  taught  from 
day  to  day  to  look  for  relief  and  restoration  to 
health.  Little,  therefore,  need  be  done  except 
to  open  the  bowels  with  some  effectual  laxative, 
and  to  apply  flannel  with  camphorated  oil,  or 
some  opiate  liniment.  But  when  paroxysms  are 
protracted  and  very  painful,  or  return  with  pro- 
gressive severity,  relief  must  be  sought  from  such 
means  as  are  in  our  power.  Many  expedients 
have  been  resorted  to,  a  large  portion  of  which 
are  liable  to  serious  objections.  Immersion  of 
the  foot  in  cold  water  has  afforded  great  relief 
to  the  pain,  but  is  liable  to  drive  the  gout  to 
vital  organs.  Bleeding  has  been  found  to  miti- 
gate the  inflammatory  action,  but  is  inadmissible 
except  in  the  most  robust  and  plethoric.  Leech- 
ing the  affected  joint  is  an  useful  palliative,  but 
even  this  has  its  limits  of  expediency.  Various 
purgative  mixtures  have  in  turn  obtained  and 
lost  a  specific  reputation. 

The  remedy  which,  in  the  present  century,  has 
taken  precedence  of  all  others  is  Colchicum. 
This  drug,  supposed  to  be  the  basis  of  a  French 
gout  medicine  called  eau  medicincde,  has  justly 
acquired  reputation  for  the  power  of  putting  an 


ON  GOUT.  145 

immediate  stop  to  the  paroxysm.  Five  grains  of 
the  powdered  root,  or  three  of  the  powdered 
seeds,  or  from  thirty  to  forty  minims  of  the  wine 
of  colchicum  root,  may  be  taken  three  times  in  a 
day  by  a  vigorous  adult.  If  the  medicine  is  good, 
it  commonly  purges  in  twenty-four  hours,  and 
sometimes  produces  vomiting,  with  prostration 
of  strength,  small  pulse,  and  cold  perspiration. 
These  effects  give  evidence  of  the  full  action  of 
the  medicine,  but  are  not  always  necessary  to  the 
cure  of  the  gouty  paroxysm.  They  disappear 
after  the  colchicum  is  omitted. 

But  the  arresting  of  the  paroxysm  does  not  in- 
volve the  cure  of  the  disease.  This  more  impor- 
tant result  requires  the  avoidance  of  the  cause 
of  the  evil.  The  prevention  of  future  paroxysms 
can  only  be  expected  from  a  careful  and  rigidly 
abstemious  regimen ;  and  this  course,  I  am  happy 
to  believe,  will  be  found  effectual  in  a  great  ma- 
jority of  cases.  I  have  known  various  examples 
of  persons  who  had  been  severely  and  repeatedly 
attacked  with  gout,  yet  who  have  been  able  to 
ward  off  subsequent  attacks  indefinitely,  by  com- 
bining a  life  of  exercise  with  total  abstinence 
from  vinous  and  stimulating  drinks.  This  method 
13 


146  ON  GOUT. 

does  not  always  succeed  in  confirmed  chronic 
gout,  but  in  preventing  the  returns  of  the  acute 
disease  it  is  eminently  successful  And  although 
in  certain  cases,  where  the  structure  and  secre- 
tions have  hecome  radically  changed  by  the  ar- 
thritic diathesis,  there  is  little  hope  of  perfect 
cure  from  any  treatment,  yet  in  the  early,  and 
sometimes  even  in  the  advanced  stages  of  this 
malady,  the  recurring  paroxysms  are  postponed, 
mitigated,  or  totally  prevented  by  entire  absti- 
nence from  vinous  and  alcoholic  stimulants.  I 
have  the  happiness  to  be  able  to  allude  to  vari- 
ous cases  of  gentlemen  well  known  in  this  city, 
in  some  of  whom  gout  has  been  hereditary,  in 
others  of  long  duration  and  great  severity,  as  in 
those  already  cited  on  page  57,  in  whom  an 
almost  perfect  exemption  from  gout,  of  indefinite 
continuance,  has  followed  an  entire  avoidance  of 
stimulating  liquids. 


APHORISMS   ON   CHOLERA. 


ON  the  first  appearance  of  Cholera  in  the  United  States,  in  1832, 
much  alarm  was  felt  throughout  the  country  in  the  prospect  of  a 
new  and  unknown  epidemic,  the  devastating  effects  of  which  had 
made  themselves  severely  felt  in  other  parts  of  the  world.  The 
following  short  article,  published  in  the  Boston  Daily  Advertiser 
of  August  20,  1832,  was  one  of  various  communications  offered  to 
allay  the  general  apprehension  prevalent  at  the  time. 

1.  When  a  disease,  which  is  pervading  the  hab- 
itable world,  appears  in  a  particular  country,  the 
inhabitants  of  that  country  must  make  up  their 
minds  to  face  it,  or  fly  before  it. 

2.  If  the  whole   population   should  abandon 
their  business,  and  spend  their  time  in  flying 
from  place  to  place,  it  is  certain  that  as  many 
would  run  into  the  disease  as  would  run  out  of 
it,  and  the  aggregate  of  distress  and  mortality 
would  be  infinitely  increased. 


148  APHORISMS   ON   CHOLERA. 

3.  If?  by  common  consent,  the  whole  population 
should  continue  their  customary  occupations  and 
intercourse,  without  shrinking  from  the  presence 
of  the  disease,  their  prosperity  would  hardly  be 
diminished,  and  the  sum  of  mortality,  in  a  given 
term  of  months  or  years,  would  hardly,  if  at  all, 
be  increased. 

4.  Xo  country  has  a  right  to  expect  uninter- 
rupted prosperity.     Of  the  scourges  which  occa- 
sionally visit  nations,  the  cholera  is  one  of  the 
slightest. 

5.  A  year  of  cholera  is  a  less  evil  than  a  year 
of  bad  government.     It  is  not  probable  that  all 
the  death  and  suffering  which  cholera  has  in- 
flicted upon  France  has  been  so  detrimental  to 
that  country  as  six  months  of  Napoleon's  admin- 
istration, or  one  of  his  campaigns. 

6.  A  year  of  cholera  is  a  less  evil  than  a  year 
of  intemperance.     Twenty  years  ago  more  life 
and  labor  was  sacrificed  in  the  United  States  to 
ardent  spirits  than  the  cholera  has  consumed  in 
any  civilized  country  of  Europe.     At  the  present 
day,  cholera,  without  intemperance,  would  be  but 
a  shadow  of  what  it  now  appears. 

7.  If  in  any  civilized  country  cholera  becomes 


APHORISMS  ON  CHOLERA.         149 

a  grievous  calamity,  it  is  chiefly  because  the  im- 
prudence, the  terror,  and  the  selfishness  of  citi- 
zens render  it  so. 

8.  History  shows  that,  in  times  of  general  pes- 
tilence, mankind,  in  proportion  to  the  state  of 
ignorance  and  ferocity,  have  given  vent  to  their 
bad  passions  in  misguided  acts  of  cruelty  and 
strife.     In  the  middle  ages,  to  obtain  satisfaction 
for  this  infliction  of  Providence,  they  massacred 
Jews  and  burnt  witches.     In  modern  times  they 
assail  municipal  governments,  attack  public  char- 
ities, mob  physicians,  and  write  newspaper  cal- 
umnies. 

9.  It  is  not  worthy  of  a  humane  and  enlight- 
ened age,  that  friends,  or  that  cities,  should  re- 
nounce intercourse  with  each  other,  on  account 
of  a  calamity  which  must  speedily  become  com- 
mon to  all  exactly  in  proportion  to  their  capacity 
to  receive  it. 

10.  Should  the  cholera  continue  to  prevail  for 
three  years  throughout  this  continent,  it  would 
cease  to  interrupt  either  business  or  recreation. 
Mankind  cannot  always   stand  aghast,  and  the 
wheels  of  society  at  length  would  no  more  be 

13* 


150  APHORISMS   OX   CHOLERA. 

impeded  by  it  than  they  now  are  by  the  existence 
of  consumption,  of  old  age,  or  of  drunkenness. 

11.  When  the  cholera  arrives  in  a  place,  it 
behoves  every  active  and  healthy  citizen  to  make 
his  will,  and  make  his  peace  with  God.  Having 
done  this,  he  should  go  about  his  ordinary  affairs 
fearlessly,  industriously,  prudently ;  avoiding  no 
situation  whatever  into  which  duty  may  call  him. 
Facts  render  it  certain  that,  as  far  as  cholera  is 
concerned,  there  are  ninety-nine  chances  in  a 
hundred  he  will  find  himself  alive  and  well  at 
the  year's  end. 


ON    THE 

TEEATMENT   OF   INJURIES 

OCCASIONED    BY 

FIRE  AND  HEATED  SUBSTANCES, 

BEING  PART  OF  A  BOYLSTON  PRIZE  DISSERTATION  FOR  1812. 


THE  application  to  living  textures  of  substances 
which  are  heated  beyond  a  certain  temperature, 
is  followed  by  the  phenomena  of  pain  and  inflam- 
mation. The  pain  is  of  a  peculiar  kind,  resem- 
bling that  from  the  continued  application  of  fire 
to  the  part ;  the  inflammation  has  a  great  ten- 
dency to  suppurate,  and  often  leaves  a  con- 
tracted cicatrix. 

The  communication  of  an  excess  of  caloric  to 
animal  bodies,  whether  living  or  dead,  is  followed 
by  certain  changes.  Of  the  fluids  some  are  coag- 
ulated, others  are  decomposed,  or  even  vaporized, 
if  the  heat  be  sufficient.  The  solids  are  in  a 


152  TREATMENT   OP 

greater  or  less  degree  expanded,  disorganized,  or 
decomposed ;  according  to  their  susceptibility 
of  change  and  the  quantity  of  caloric  received. 
These  processes  in  the  living  body  being  incom- 
patible with  its  healthy  condition,  a  morbid  state 
of  the  part  affected  necessarily  ensues.  This 
state  is  marked  by  pain,  redness,  swelling,  ves- 
ication,  suppuration,  or  mortification ;  accord- 
ing to  the  degree  and  extent  of  the  injury  suf 
fered. 

The  distressing  effects  of  these  injuries,  when 
they  exist  in  an  extensive  degree,  are  exceeded 
by  few  diseases.  Yery  dangerous  cases  often 
occur  in  children,  whose  clothes  are  accidentally 
kindled  ;  in  intoxicated  persons,  who  fall  into  the 
fire ;  and  in  those  exposed  by  conflagrations,  or 
by  explosions  of  gunpowder,  steam-boilers,  and 
the  inflammable  gases  of  mines.  The  peculiar 
appearance  of  a  burnt  surface  has  commonly  been 
supposed  to  require  a  peculiar  treatment ;  and 
many  practitioners,  instead  of  resorting  to  the 
general  remedies  of  inflammation,  have  placed 
their  reliance  on  the  supposed  powers  of  specific 
remedies.  In  this  way  different  and  opposite 
modes  of  treatment  have  been  adopted,  whose 


INJURIES   BY   FIRE.  153 

apparent  success  or  failure  at  different  times  has 
occasioned  disputes  respecting  their  comparative 
efficacy.  After  a  variety  of  trials  have  been  made, 
and  a  multitude  of  cases  detailed,  the  practice 
still  remains  undecided ;  and  methods  of  treat- 
ment diametrically  opposite  enlist  nearly  an  equal 
number  of  advocates. 

The  two  modes  of  treating  burns  and  scalds, 
which  have  recently  acquired  the  greatest  share 
of  notice,  are  those  of  Mr.  Kentish  and  of  Sir 
James  Earle.  The  former  of  these  consists  in 
the  use  of  stimulant,  the  latter  of  cooling,  appli- 
cations. 

Mr.  Kentish  recommends  that  the  injured  sur- 
face be  in  the  first  place  washed  and  bathed  with 
rectified  spirit  of  wine,  spirit  of  turpentine,  or 
some  similar  application,  which  has  been  previ- 
ously heated  as  far  as  it  can  be  borne  with  the 
finger.  After  this  bathing  has  been  repeated 
two  or  three  times,  the  whole  is  then  to  be  cov- 
ered with  plasters  made  of  common  basilic  on  or 
resinous  ointment,  thinned  to  the  consistence  of 
a  liniment  with  spirit  of  turpentine.  This  dress- 
ing is  to  be  continued  for  twenty-four  hours, 
after  which  its  place  may  be  supplied  with  some 


154  TKEATMENT  OF 

less  stimulating  substance,  such  as  proof  spirit  or 
laudanum,  with  the  coldness  taken  off.  At  the 
end  of  forty-eight  hours,  Mr.  K.  observes,  the 
inflammation  will  generally  be  found  to  have  dis- 
appeared, at  which  time  the  part  may  be  dressed 
with  camphorated  oil,  with  Goulard's  cerate,  or 
with  cerate  of  lapis  calaminaris. 

The  internal  treatment  recommended  by  Mr. 
Kentish  is  also  stimulant.  Wine,  ale,  alcohol  or 
laudanum,  are  advised  to  be  used  according  to 
circumstances. 

Sir  James  Earle,  in  a  publication,  entitled  "  An 
Essay  on  the  Means  of  lessening  the  Effects  of 
Fire  on  the  Human  Body,"  defends  a  mode  of 
treatment  directly  the  reverse  of  the  former. 
This  consists  of  the  antiphlogistic  regimen  inter- 
nally, together  with  the  application  of  cold  in  the 
form  of  water,  snow,  or  pounded  ice,  to  the  part 
affected.  Sir  "Walter  Farquhar  and  Dr.  Kinglake 
advocate  the  same  mode  of  procedure ;  and  the 
cases  related  to  substantiate  the  happy  effect  of 
the  cooling  treatment  are  not  less  numerous  than 
those  in  favor  of  the  terebinthinate  remedies. 

The  disputes  on  the  comparative  efficacy  of 
the  foregoing  plans  of  treatment  have  been  agi- 


INJURIES  BY  FIRE.  155 

tated  with  so  much  warmth  and  so  little  impar- 
tiality, that  the  reader  of  them  is  like  to  end  his 
inquiries  in  scepticism  rather  than  conviction. 
Inconsistent  and  opposite  facts  are  often  stated, 
and  the  same  cases  distorted  to  prove  both  points 
of  the  dispute.  For  instance,  the  remarkable  case 
of  Boerhaave,  who  was  violently  scalded  by  the 
bursting  of  Papin's  digester,  and  who  got  well 
under  copious  bleeding  and  purging,  is  cited  by 
one  as  an  instance  of  a  speedy  and  fortunate  cure, 
and  by  another  as  a  tedious  and  difficult  recovery, 
which  might  have  taken  place  in  half  the  time  un- 
der a  different  mode  of  treatment.  The  source  of 
this  uncertainty  seems,  firstly,  to  consist  in  mak- 
ing practical  deductions  from  individual  or  insu- 
lated cases,  which  do  not  afford  sufficient  room 
for  a  comparison  of  the  effect  of  different  reme- 
dies. Such  is  the  idiosyncrasy  of  different  con- 
stitutions, and  so  deceptive  the  appearance  of 
different  injuries,  that  it  is  often  impossible  to 
pronounce  in  what  degree  two  cases  resemble 
each  other,  and  in  what  degree  any  application 
has  actually  expedited  or  retarded  the  cure.  Ac- 
cording to  the  caprice  or  prejudice  of  practition- 
ers, the  account  of  a  case  may  be  warped  and 


156  TREATMENT  OF 

colored  in  such  a  manner  as  to  prove  any  point 
of  a  dispute  that  is  wished.  For  example,  should 
any  one  come  forth  as  the  advocate  for  a  negative 
mode  of  treating  burns,  which  should  consist  in 
letting  them  alone,  or  in  leaving  the  process  to 
nature,  there  is  no  doubt  that  in  due  time  he 
would  be  able  to  collect  a  sufficient  number  of 
apparently  satisfactory  cases  to  answer  all  his 
purposes.  The  multitude  of  cases  brought  for- 
ward by  Mr.  Kentish  and  his  opponents,  in  the 
aggregate,  seems  only  to  prove  that  oil  of  tur- 
pentine and  cold  water  are  both  salutary,  and 
both  pernicious,  according  as  the  practitioner 
who  watched  their  influence  was  under  the  prej- 
udices of  a  favorable  or  unfavorable  nature 
toward  either  application.  A  second  ground  of 
error  is  likewise  contained  in  the  supposition 
that  a  single  and  specific  mode  of  treatment  can 
be  accommodated  to  all  states  and  degrees  of  the 
injuries  occasioned  by  fire. 

It  is  obvious  that  many  more  cases  may  yet 
be  detailed,  which  will  not  bring  the  question, 
in  the  least,  nearer  to  a  decision.  Though  a 
series  of  observations,  by  a  faithful  and  intelli- 
gent practitioner,  is  entitled  to  respect,  yet 


INJUBIES   BY   FIEE.  157 

when  two  such  courses  present  us  with  results 
diametrically  opposite,  we  are  justified  in  doubt- 
ing the  validity  of  the  ground  on  which  they  are 
founded. 

It  occurred  to  me,  that,  could  a  measure  be 
devised  of  inflicting  two  equal  burns  on  corre- 
sponding parts  of  the  same  animal,  which  should 
afterward  be  treated  with  different  applications, 
a  chance  would  be  afforded  of  testing  the  com- 
parative efficacy  of  these  applications.  With 
this  view  the  following  experiments  were  insti- 
tuted, which,  though  not  so  numerous  and  com- 
plete as  could  have  been  wished,  will  not,  it  is 
hoped,  be  thought  altogether  inapplicable  to  the 
object  for  which  they  were  attempted. 

EXPERIMENT    I. 

The  two  ears  of  a  full-grown  rabbit  were  im- 
mersed in  water,  heated  near  to  the  boiling  point. 
Particular  care  was  taken  to  immerse  both  ears 
at  the  same  instant,  to  plunge  them  to  the  same 
depth,  and  to  withdraw  them  together.  In  this 
way  two  scalds  were  obtained,  as  nearly  as  pos- 
sible equal ;  since  they  were  inflicted  by  the 
same  substance  at  an  uniform  temperature,  ap- 
14 


158  TREATMENT   OF 

plied  for  an  equal  extent  and  length  of  time  to 
parts  corresponding  to  each  other,  equidistant 
from  the  centre  of  circulation,  and  both  apper- 
taining to  the  same  subject.  The  animal  was 
now  suspended  on  his  back,  with  his  right  ear 
immersed  in  a  vessel  of  warm  water,  at  about 
100°  of  Fahrenheit ;  the  left  in  a  vessel  of  cold 
water,  having  its  temperature  reduced  by  ice. 
In  this  way  they  continued  for  three  quarters  of 
an  hour,  the  temperature  of  both  vessels  being 
kept  as  regular  as  possible  by  the  occasional  ad- 
dition of  warm  water  and  of  ice.  The  two  ears 
were  then  wiped  dry  and  covered  with  common 
resinous  ointment. 

2d  day.  —  The  right  ear,  to  which  warm  water 
had  been  applied,  was  red  and  opaque,  but  the 
skin  remained  sound ;  the  left  was  evidently  more 
inflamed,  and  contained  several  small  vesications 
and  excoriations.  The  heat  of  both  was  some- 
what above  the  natural  standard. 

3d  day. —  The  cuticle  had  separated  from  both 
ears  to  some  extent,  but  most  from  the  left,  to 
which  the  cold  application  had  been  made.  A 
small  slough  likewise  separated  from  this  ear. 


INJUEIES   BY   FIEE.  159 

4th  day.  —  Additional  portions  had  separated 
from  both  ears,  but  most  from  the  left. 

From  the  fifth  to  the  eighteenth  day  both  ears 
continued  in  a  state  of  ulceration.  The  tip  of 
the  ears  having  been  the  first  part  immersed,  and 
the  last  withdrawn,  was  of  course  the  most  in- 
tensely scalded,  and  sloughed  off  from  both  to 
some  extent.  The  left  ear,  which  had  undergone 
the  cold  treatment,  suffered  most  by  gangrene, 
and  was  several  days  later  than  the  other  in 
healing. 

EXPEEIMENT    II. 

The  two  ears  of  a  rabbit  were  immersed  in 
scalding  water  as  formerly.  The  right  ear  was 
covered  as  far  as  it  was  scalded  with  the  stimu- 
lating ointment  of  Mr.  Kentish,  made  of  basilicon, 
thinned  to  the  consistence  of  a  liniment  with  oil 
of  turpentine.  To  the  left  ear  was  applied  a 
saponaceous  liniment,  composed  of  equal  parts 
of  lime-water  and  olive-oil. 

Three  hours  afterward  the  ears  were  examined. 
The  heat  of  both  was  much  increased,  but  that  of 
the  right,  to  which  the  spirit  of  turpentine  had 
been  applied,  was  evidently  greatest.  The  pain 


160  TREATMENT   OF 

of  this  ear  was  likewise  evinced  by  the  animal 
lopping  it  or  laying  it  on  its  back,  while  the 
other  was  carried  upright.  Some  small  blisters 
had  risen  on  this  ear,  but  none  were  observed  on 
the  other. 

2d  day. — Both  ears  were  preternaturally  warm 
and  red,  the  right  continuing  more  so.  They  were 
now  covered  with  resinous  ointment. 

3d  day.  —  A  part  of  the  tip  of  the  right  ear 
separated,  and  some  of  the  remainder  appeared 
destitute  of  sensation.  The  left  was  red  and 
inflamed,  but  with  no  appearance  of  mortifica- 
tion. 

4th  and  5th  days. — More  of  the  right  ear  came 
off.  The  left  was  ulcerated,  but  without  any  ap- 
pearance of  gangrene. 

6th  —  8th  days.  —  The  ulceration  continued 
without  any  slough  from  the  left  ear.  About 
the  ninth  day,  the  weather,  which  had  been  tem- 
perate, became  cool ;  and  the  ears,  which  were 
kept  moist  by  the  ointment  and  their  own  dis- 
charge, became  constantly  cold.  To  this  circum- 
stance I  attributed  the  formation  of  a  considera- 
ble slough,  which  came  from  the  right  ear  about 


INJURIES   BY   FIRE.  161 

the  tenth,  and  from  the  left  on  the  fourteenth  day. 
Both  ears  soon  after  healed. 

EXPERIMENT    III. 

The  ears  of  a  rabbit  being  equally  scalded  as 
before,  the  right  was  covered  with  Mr.  Kentish's 
ointment,  while  the  left  was  immersed  in  cold 
water  with  ice  for  three  quarters  of  an  hour. 
The  left  was  then  covered  with  basilicon,  which 
ointment  on  the  second  day  was  applied  to  both. 

2d  day.  —  The  right  ear  was  blistered,  and  dis- 
charged a  considerable  quantity  of  serum  or  pus. 
The  left  was  in  a  similar  situation,  but  in  a  less 
degree. 

3d  day.  —  Both  ears  were  in  a  state  of  suppu- 
ration, but  the  right  much  the  worst ;  the  dis- 
charge from  this  ear  being  general,  from  the 
other  partial. 

The  right  ear  continued  to  appear  the  worst 
during  the  recovery,  which  was  not  complete 
before  the  thirtieth  day.  The  loss  of  substance 
by  sloughing  was  not  great  from  either  ear,  but 
was  least  from  the  left. 
14* 


162  TKEATMENT  OF 

EXPEEQIENT  IV. 

A  fourth,  rabbit  was  dipped  in  the  same  man- 
ner with  the  others  ;  afterwards  one  ear  was  im- 
mersed in  water,  the  other  in  proof  spirit  at  the 
temperature  of  the  room.  The  scalds,  however, 
proved  to  be  slight,  as  nothing  ensued  but  a  tri- 
fling redness  and  opacity  in  the  parts  immersed, 
which  disappeared  in  two  or  three  days,  and 
nearly  at  the  same  time  from  both.  This  experi- 
ment would  not  have  been  mentioned,  did  it  not 
serve  to  show  the  ground  for  fallacy,  which  arises 
from  comparing  the  cases  of  different  individuals. 
Had  the  result  of  this  case  been  contrasted  with 
any  of  the  former,  on  presumption  that  the  inju- 
ries received  were  equal,  a  very  erroneous  deduc- 
tion might  have  been  the  consequence. 

The  foregoing  experiments  were  conducted  on 
a  plan,  which,  I  conceive,  were  it  pursued  to  a 
considerable  extent,  would  approach  as  near  to 
demonstrative  certainty  as  any  subject  in  conjec- 
tural science  of  medicine  is  capable  of  arriving. 
A  desire  of  the  truth,  however,  obliges  me  to 
state  the  difficulties  which  remain,  and  which 
may  seem  to  detract  something  from  the  weight 


mJTJKIES   BY   FIRE.  163 

of  the  experiments.  The  ear,  which  was  the  part 
subjected  to  experiment,  is  composed  chiefly  of 
cartilage  and  skin  j  it  is  remote  from  the  centre 
of  circulation,  and  its  powers  of  life  compara- 
tively feeble.  Possibly  a  different  mode  of  treat- 
ment may  suit  this  part  from  that  which  agrees 
with  muscles  and  cellular  substance.  This  is  not 
to  be  considered  as  very  probable,  since  the  liv- 
ing animal  fibre  is  apt  to  exhibit  similar  phenom- 
ena in  any  part  of  the  body  under  the  influence 
of  the  same  disease.  If  any  peculiarity  existed 
in  the  ear,  it  was  probably  that  of  being  less  sus- 
ceptible of  the  action  of  stimuli.  A  trial  would 
have  been  made  with  some  more  central  part, 
had -the  operation  been  equally  convenient.  A 
second  imperfection  in  these  experiments  was 
caused  by  the  accession  of  cold  weather,  which 
apparently  occasioned  a  more  extensive  gan- 
grene than  would  have  ensued  under  the  use 
of  the  remedies  without  this  circumstance.  It 
did  not,  however,  occur  during  the  first  days,  so 
that  the  following  appearances  may  be  considered 
as  free  from  fallacy. 

1st.  The  evident  increase  of  heat,  pain,  redness, 


164  TREATMENT  OP 

vesication,  and  gangrene,  following  the  applica- 
tion of  oil  of  turpentine.  Ex.  n.  and  m. 

2d.  The  increase  of  most  of  the  same  appear- 
ances, where  cold  water  was  used  in  contrast 
with  warm.  Ex.  I. 

As  comparative  cases  come  within  the  plan  of 
these  remarks,  the  following  case,  in  which  differ- 
ent remedies  were  applied  to  the  same  subject,  is 
extracted  from  the  Medical  and  Physical  Journal, 
vol.  XVIIL,  page  209. 

"  Samuel  James,  aged  forty,  had  his  face,  hands 
and  back  most  severely  burnt  by  the  explosion 
of  hydrogen  gas  in  a  coal  mine.  The  cold  appli- 
cation was  used  to  the  face  and  hands  ;  the  warm 
oil  of  turpentine,  according  to  Mr.  Kentish's  plan 
(originally  recommended  by  Heister),  was  applied 
to  the  back,  and  dressed  afterward  with  unguent, 
resinae  flav.  softened  down  with  the  same  :  in 
order  to  try  which  mode  of  treatment  afforded 
the  most  immediate  ease  to  the  patient,  as  well 
as  the  most  expeditious  cure.  According  to  the 
patient's  own  account,  the  pain  of  the  hands  and 
face  was  immediately  relieved  by  the  cold  appli- 
cation; but  he  complained  of  the  oil  of  turpentine 
occasioning  a  smarting  sensation  on  the  back  for 


INJUEIES  BY  FIEE.  165 

five  or  six  hours.  This  mode  of  dressing  was 
continued  for  the  space  of  two  days ;  but,  observ- 
ing a  considerable  degree  of  inflammation  remain- 
ing from  the  terebinthinate  application,  that  dress- 
ing was  changed  for  the  neutralized  cerate,  which 
the  patient  did  not  observe,  his  eyes  being  closed 
by  the  great  tumefaction  of  the  face  ;  but  he  ex- 
pressed the  utmost  satisfaction  from  the  superior 
comfort  he  felt  in  that  dressing  compared  with 
the  former.  The  next  day  the  back  appeared 
much  less  inflamed,  continued  gradually  getting 
better,  and  was  cured  in  three  weeks.  '  I  am 
confident,'  says  Dr.  Evans,  the  relater  of  the 
case, '  the  back  would  have  gotten  well  sooner 
under  the  cooling  plan  of  treatment;  for  the 
patient  constantly  complained  of  the  great  heat 
in  the  part  during  the  application  of  the  oil  of 
turpentine.' " 

In  a  variety  of  cases  which  have  occurred  un- 
der my  own  observation,  it  has  not  been  practi- 
cable to  contrast  the  eifects  of  different  dress- 
ings ;  so  that  little  of  a  decisive  nature  can  be 
gathered  from  them.  In  one  case,  however, 
which  I  witnessed,  of  a  very  severe  and  exten- 
sive burn  in  a  child  aged  ten  years,  which  was 


166  TREATMENT   OF 

occasioned  by  the  clothes  taking  fire,  and  which 
afterward  terminated  fatally,  the  application  of 
the  oil  of  turpentine  in  the  form  of  a  liniment 
produced  the  most  violent  aggravation  of  pain, 
which  did  not  cease  before  the  patient  was 
thrown  into  convulsions.  Instances  of  the  same 
effect  have  been  mentioned  to  me  by  several 
medical  friends. 

Most  writers,  who  appear  as  principal  advo- 
cates of  any  mode  of  practice,  feel  obliged  to  pro- 
duce something  like  a  theory  or  rationale,  which 
shall  account  for,  or  at  least  apply  to,  the  facts 
and  phenomena  adduced.  Accordingly,  Mr.  Kent- 
ish and  the  others  have  not  omitted  to  back 
their  catalogue  of  cases  with  a  train  of  reasoning 
illustrative  of  the  propriety  of  their  special  appli- 
cations. Of  these  the  two  principal  are  entitled 
to  a  separate  attention. 

OF  THE  STBTTJLAXT  PLAN. 

In  defence  of  the  oil  of  turpentine  and  other 
stimulant  applications,  Mr.  Kentish  states  the  fol- 
lowing as  a  law  of  the  system :  "  That  any  part 
of  the  system  having  its  action  increased  to  a 
very  high  degree,  must  continue  to  be  excited, 


INJUEIES  BY  FIRE.  167 

though  in  a  less  degree,  either  by  the  stimulus 
which  caused  the  increased  action,  or  some  other 
having  the  nearest  similarity  to  it ;  until,  by  de- 
grees, the  extraordinary  action  subsides  into  the 
healthy  action  of  the  part."  It  has  also  been 
urged,  by  supporters  of  the  plan,  that  a  lesser 
stimulus,  as  the  oil  of  turpentine,  is  compara- 
tively sedative  in  its  operation  on  a  part  violently 
excited  by  a  burn.  The  above  reasoning  may 
amuse  the  imagination,  but  does  not  satisfy  the 
judgment.  The  analogy  of  almost  every  subject 
in  medicine  and  surgery  teaches  us  that  a  part 
already  highly  irritated  receives  no  benefit  from 
an  additional  stimulus,  which  must  tend  only  to 
increase  the  sum  of  the  irritation.  If  a  man 
bruise  his  finger,  do  we,  by  way  of  expediting 
the  cure,  proceed  to  bruise  it  again,  but  with  less 
violence,  because  "it  must  continue  to  be  excited 
in  a  less  degree,"  "  until  the  extraordinary  action 
subsides  into  the  healthy  action  of  the  part "  ? 
Or  if  a  man  has  received  an  hundred  lashes,  shall 
a  surgeon  prescribe  ninety  more,  because  ninety 
lashes  are  less  stimulating  than  an  hundred,  and 
therefore  comparatively  sedative  ?  The  propriety 
is  just  the  same,  when  we  irritate  with  acrid  spirit 


168  TREATMENT    OF 

of  turpentine  a  part  already  suffering  violent  pain 
and  inflammation,  as  well  as  increased  sensibility, 
from  a  burn.  Though  the  spirit  of  turpentine 
applied  to  a  healthy  surface  is  less  injurious  than 
fire,  yet,  if  we  apply  the  one  to  a  part  already  in- 
jured by  the  other,  we  only  inflict  a  double  evil, 
or  produce  an  aggregate  of  the  mischief  of  both. 
With  regard  to  the  internal  stimulant  plan  of 
Mr.  Kentish,  it  is  advocated  on  a  ground  not  less 
exceptionable.  He  assumes  it  as  a  fact  that  "  a 
healthy,  vigorous  man  "  suffers  less  by  a  burn,  of 
the  same  extent,  than  "a  man  of  an  irritable 
habit  j "  and  from  thence  he  infers  that  strength 
resists  the  ill  'consequences  of  these  injuries, 
while  weakness  promotes  them ;  and  that  there- 
fore, in  all  cases,  "  we  should  make  the  system  as 
strong  as  we  can  immediately  on  the  attack." 
Whether  this  principle  be  just  may  very  prop- 
erly be  questioned,  since  it  is  an  admitted  fact 
that,  from  ordinary  mechanical  injuries,  a  vigor- 
ous, plethoric  man  suffers  a  higher  degree  of 
inflammation,  than  one  whose  strength  and  quan- 
tity of  blood  are  less,  and  whose  powers  of  reac- 
tion of  course  are  more  feeble.  When  a  common 
injury  takes  place,  which  is  capable  of  producing 


INJUBIES   BY   FIEE.  169 

inflammation  and  symptomatic  fever,  depletion 
and  the  antiphlogistic  regimen  are  resorted  to  as 
preventives ;  and  this  in  a  greater  or  less  degree, 
according  as  the  subject  is  more  or  less  plethoric. 
For  instance,  if  a  vigorous  man  receive  a  contus- 
ion on  any  part  of  his  body,  so  violent  as  to  en- 
danger suppuration  or  gangrene,  we  prevent  or 
mitigate  these  symptoms  by  blood-letting,  purg- 
ing and  abstinence.  Now,  if  the  same  man  had 
received  a  burn  on  the  same  part,  endangering 
the  same  symptoms,  ought  our  practice  to  be 
different  ?  Is  the  system  so  revolutionized  as  to 
require  opposite  treatment,  because  an  injury  is 
caused  by  fire  instead  of  mechanical  violence  ? 
Or  is  a  stout  and  plethoric  patient,  with  a  full, 
hard  and  frequent  pulse,  to  be  stimulated  with 
brandy  and  laudanum,  because  his  fever  origi- 
nated in  a  burn  ?  It  is  certainly  the  height  of 
empiricism  to  prescribe  a  specific  mode  of  treat- 
ment for  a  disease  merely  from  its  name.  A 
rational  treatment  is  always  dependent  on  cir- 
cumstances, and  is  stimulant  or  sedative,  accord- 
ing to  the  constitution  of  the  patient,  the  state 
of  the  pulse,  and  the  condition  of  the  system. 
15 


170  TREATMENT  OF 

OF  THE  COOLING  PLAN. 

Sir  James  Earle  and  Dr.  Kinglake,  the  former 
in  his  Essay,  and  the  latter  in  the  Medical  and 
Physical  Journal,  have  advocated  a  mode  of  treat- 
ment precisely  opposite  to  that  of  Mr.  Kentish ; 
yet,  like  him,  they  seem  to  have  erred  in  pursu- 
ing a  favorite  remedy  to  extremes.  The  general 
and  continued  application  of  cold  to  a  part  in- 
jured by  a  burn  or  scald,  is  resorted  to,  from  a 
belief  of  its  tendency  to  abstract  the  excess  of 
caloric  from  the  part,  and  to  restore  the  equilib- 
rium. This  belief  is  a  just  one,  so  far  as  it  ap- 
plies to  the  application  of  cold  for  a  short  time, 
immediately  after  the  injury  from  a  heated  sub- 
stance is  received;  but  the  continued  application 
of  it  for  hours  and  days,  on  the  same  principle,  is 
altogether  unphilosophical,  and  has  been  suffi- 
ciently refuted  in  the  treatise  of  Mr.  Kentish. 
Every  particle  of  caloric  communicated  to  the 
living  body  by  a  hot  substance  may  be  abstracted 
in  one  minute  by  plunging  the  part  affected  in 
cold  water  ;  and,  if  this  immersion  be  continued, 
the  temperature  will  soon  be  reduced  below  the 
natural  standard.  It  is  true  that,  on  withdrawing 
the  affected  part,  its  temperature  will  soon  rise 


INJUEIES  BY   FIEE.  171 

to  the  former  pitch ;  but  this  increased  tempera- 
ture can  be  nothing  more  than  animal  heat,  a 
little  increased  by  the  violent  action  of  the  part, 
as  happens  in  most  cases  of  inflammation.  As  to 
the  common  phrase  of  "killing  the  fire/'  by  which 
is  meant  only  the  relief  of  pain  that  takes  place  at 
the  commencement  of  resolution  or  suppuration, 
this  cannot  be  hastened  by  cold  applications,  ex- 
cept in  slight  cases  which  admit  of  resolution  ; 
whereas,  in  cases  where  blisters  have  arisen,  and 
suppuration  is  about  to  take  place,  its  progress  is 
only  retarded  by  the  employment  of  cold. 

"With  regard  to  the  antiphlogistic  regimen 
nothing  more  need  be  said  than  that  its  use  or 
omission  must  be  determined  altogether  by  the 
state  of  the  system. 

It  may  be  proper  in  this  place  to  say  something 
respecting  the  use  of  alcohol,  ether,  and  proof 
spirit.  These  substances  are  often  recommended 
in  a  vague  manner,  without  reference  to  the  mode 
of  their  application,  although  on  this  circumstance 
depends  their  efficacy.  If  a  part  of  the  body  be 
washed  with  cold  spirit,  or  a  thin  cloth  wet  with 
spirit  be  applied,  the  rapid  evaporation  which 
*akes  place  renders  the  effect  powerfully  refrig- 


172  TREATMENT   OF 

eraut.  On  the  contrary,  if  the  part  be  immersed 
in  spirit,  or  the  spirit  be  applied  warm,  or  with 
a  thickly  folded  cloth,  its  operation  is  unques- 
tionably that  of  a  stimulant. 

After  considering  at  length  the  opposite  ex- 
tremes of  treatment  which  have  been  adopted, 
the  result  of  both  reason  and  experiment  appears 
to  be  that  the  two  extremes  are  alike  injudicious 
when  pursued  in  their  full  extent,  and  neither  of 
them  suited  to  the  varieties  of  burns  and  of  con- 
stitutions. An  intermediate  plan  of  treatment, 
which  shall  vary  according  to  circumstances,  and 
be  dependent  on  the  degree  and  state  of  disease, 
is  undoubtedly  the  most  deserving  of  attention. 

In  slight  burns,  where  no  vesications  take 
place,  and  where  resolution  appears  practicable, 
we  should  resort  to  cooling  applications,  either 
water  or  of  spirit ;  since  in  this  way  the  most 
speedy  relief  is  generally  given  to  the  pain,  and 
likewise,  as  in  other  inflammations,  resolution  is 
accelerated.  The  preparations  of  lead,  or  any 
other  discutient,  may  be  added  when  thought 
proper.  In  all  cases  of  burns  and  scalds  it  may 
be  expedient  to  make  one  application  of  cold 
\vater  as  soon  as  possible  after  the  injury,  to  ab- 


INJUKIES   BY   FIRE.  173 

stract  the  heat  from  the  clothes,  skin,  &c.,  and 
prevent  the  spreading  of  its  effects. 

In  more  violent  burns,  attended  with  blisters 
and  acute  pain,  a  permanent  relief  is  to  be  ex- 
pected only  from  suppuration.  This  is  promoted, 
as  in  other  cases  of  suppurative  inflammation,  not 
by  acrid  stimulants,  not  by  snow  and  ice,  but  by 
mild  emollients  and  warm  fomentations  or  poul- 
tices. Though  cold  applications,  by  benumbing 
the  nerves,  may  afford  a  temporary  relief  of  pain, 
yet  this  returns  with  equal  or  increased  violence 
when  these  applications  are  discontinued ;  so  that 
they  must  be  persevered  in  for  a  long  time,  until 
tardy  suppuration  appears  in  spite  of  them,  before 
effectual  relief  is  given.  In  the  first  experiment 
on  the  rabbits,  the  ear  which  was.  immersed  in 
cold  water  fared  worse  than  its  fellow,  which 
was  dipped  in  warm.  In  the  treatment  of  burns 
tending  to  suppuration,  perhaps  no  application 
is  better  than  a  liniment  of  lime-water  and  oil. 
This  is  very  gently  soothing  and  astringent,  and 
by  its  saponaceous  quality  unites  with  the  dis- 
charge, and  is  thus  more  generally  and  equally 
applied  than  any  unctuous  substance  would  be 
in  its  place. 

15* 


174  TREATMENT   OF 

In  very  violent  burns,  where  the  life  of  a  part 
is  destroyed,  or  where  the  inflammation  is  so 
great  as  to  render  mortification  to  a  considera- 
ble extent  probable,  our  treatment  must  depend 
on  the  state  of  the  system  and  the  appearance  of 
the  part.  If  marks  of  active  inflammation  are 
present,  with  increased  heat  and  force  of  circula- 
tion, a  sedative  and  depleting  plan  is  to  be  fol- 
lowed, until  the  violent  action  has  abated.  On 
the  contrary,  if  the  inflammation  be  of  the  passive 
kind,  with  diminished  action  of  the  part,  and 
atony  and  prostration  of  strength  in  the  system, 
we  may  then  depend  on  stimulants  and  antisep- 
tics. It  can  be  only  in  burns  of  this  kind  that 
Mr.  Kentish's  method  of  treatment  is  admissible 
in  any  extent. 

In  the  subsequent  treatment  of  burns,  if  exu- 
berant granulations  arise,  they  may  be  repressed 
by  gentle  astringents,  by  pressure,  or  by  escha- 
rotics.  Mr.  Kentish  recommends  powdered  chalk ; 
but  this  I  have  found  insufficient  when  mixed 
with  a  third  part  of  burnt  alum.  Pure  alum  an- 
swers the  purpose  perfectly  well.  The  separa- 
tion of  sloughs  is  facilitated,  according  to  Mr. 


INJURIES   BY   FIRE.  175 

Kentish,  by  introducing  powdered  chalk  into  the 
cavities  between  them  and  the  living  parts. 

The  contraction  of  the  cicatrix  is  often  an  un- 
pleasant consequence  of  burns.  It  may  be  obvi- 
ated in  a  degree  by  a  proper  position  of  the  cica- 
trizing part.  Sometimes  the  contraction  is  so 
great  as  to  impede  circulation ;  in  which  case  it 
is  necessary  to  divide  the  newly-formed  skin  in 
different  places,  thus  allowing  it  room  to  expand. 


ON     THE 

BURIAL  OF  THE  DEAD. 


THE  interest  which  the  author  has  felt  in  the  Cemetery  at  Mount 
Auburn,  the  first  of  its  kind  in  the  United  States,  has  in  a  measure 
grown  out  of  his  personal  connection  with  its  foundation  and  sub- 
sequent development.  The  project  of  Mount  Auburn  was  origin- 
ally conceived,  the  preparatory  meetings  called,  the  land  selected 
and  engaged,  and  the  larger  public  structures,  the  gate,  chapel, 
tower  and  iron  fence  designed,  by  himself  at  different  times.*  The 
pleasure  of  witnessing,  through  so  many  years,  the  progressive 
improvement  of  this  beautiful  spot,  has  been  enhanced  by  the  in- 
terest and  active  cooperation  of  many  of  our  distinguished  and 
valued  citizens. 

While  the  subject  was  of  recent  agitation,  the  following  Address 
was  delivered  at  the  hall  of  the  Masonic  Temple,  before  the  Boston 
Society  for  the  Promotion  of  Useful  Knowledge. 

THE  manner  in  which  we  dispose  of  the  re- 
mains of  our  deceased  friends  is  a  subject  which, 

*  Historical  notices  of  Mount  Auburn  have  been  published  by 
Thacher,  Walter,  Dearborn,  and  others,  also  in  the  Daily  Adver- 
tiser, Sept.  9,  1851,  and  the  Boston  Atlas,  Sept.  16,  1851. 


ON  THE  BURIAL  OF  THE  DEAD.       177 

within  the  last  few  years,  has  occupied  a  greater 
share  than  formerly  of  the  public  attention  in  our 
own  vicinity.  It  involves  not  only  considerations 
which  belong  to  the  general  convenience,  but  in- 
cludes also  the  gratification  of  individual  taste, 
and  the  consolation  of  private  sorrow.  Although, 
in  a  strictly  philosophical  view,  this  subject  pos- 
sesses but  little  importance,  except  in  relation  to 
the  convenience  of  survivors  ;  yet  so  closely  are 
our  sympathies  enlisted  with  it,  so  inseparably 
do  we  connect  the  feelings  of  the  living  with  the 
condition  of  the  dead,  that  it  is  in  vain  that  we 
attempt  to  divest  ourselves  of  its  influence.  It  is 
incumbent  on  us  therefore  to  analyze,  as  far  as 
we  may  be  able,  the  principles  which  belong  to  a 
correct  view  of  this  subject ;  since  it  is  only  by 
understanding  these,  that  we  may  expect  both 
reason  and  feeling  to  be  satisfied. 

The  progress  of  all  organized  beings  is  towards 
decay.  The  complicated  textures'  which  the  liv- 
ing body  elaborates  within  itself  begin  to  fall 
asunder  almost  as  soon  as  life  has  ceased.  The 
materials  of  which  animals  and  vegetables  are 
composed  have  natural  laws  and  irresistible  affin- 
ities, which  are  suspended  during  the  period  of 


178  ON  THE  BURIAL 

life,  but  which  must  be  obeyed  the  moment  that 
life  is  extinct.  These  continue  to  operate  until 
the  exquisite  fabric  is  reduced  to  a  condition  in 
no  wise  different  from  that  of  the  soil  on  which 
it  has  once  trodden.  In  certain  cases  art  may 
modify,  and  accident  may  retard,  the  approaches 
of  disorganization,  but  the  exceptions  thus  pro- 
duced are  too  few  and  imperfect  to  invalidate 
the  certainty  of  the  general  law. 

If  we  take  a  comprehensive  survey  of  the  prog- 
ress and  mutations  of  animal  and  vegetable  life, 
we  shall  perceive  that  this  necessity  of  individual 
destruction  is  the  basis  of  general  safety.  The 
elements  which  have  once  moved  and  circulated 
in  living  frames  do  not  become  extinct  nor  use- 
less after  death ;  they  offer  themselves  as  the 
materials  from  which  other  living  frames  are  to 
be  constructed.  What  has  once  possessed  life 
is  most  assimilated  to  the  living  character,  and 
most  ready  to  partake  of  life  again.  The  plant 
which  springs  from  the  earth,  after  attaining  its 
growth  and  perpetuating  its  species,  falls  to  the 
ground,  undergoes  decomposition,  and  contrib- 
utes its  •  remains  to  the  nourishment  of  plants 
around  it.  The  myriads  of  animals  which  range 


OF  THE   DEAD.  179 

the  woods,  or  inhabit  the  air,  at  length  die  upon 
the  surface  of  the  earth,  and,  if  not  devoured  by 
other  animals,  prepare  for  vegetation  the  place 
which  receives  their  remains.  Were  it  not  for 
this  law  of  nature,  the  soil  would  be  soon  ex- 
hausted, the  earth's  surface  would  become  a 
barren  waste,  and  the  whole  race  of  organized 
beings,  for  want  of  sustenance,  would  become 
extinct. 

Man  alone,  the  master  of  the  creation,  does  not 
willingly  stoop  to  become  a  participator  in  the 
routine  of  nature.  In  every  age  he  has  mani- 
fested a  disposition  to  exempt  himself,  and  to 
rescue  his  fellow,  from  the  common  fate  of  living 
beings.  Although  he  is  prodigal  of  the  lives  of 
other  classes,  and  sometimes  sacrifice^  a  hundred 
inferior  bodies  to  procure  himself  a  single  repast, 
yet  he  regards  with  scrupulous  anxiety  the  desti- 
nation of  his  own  remains  ;  and  much  labor  and 
treasure  are  devoted  by  him  to  ward  off  for  a 
season  the  inevitable  courses  of  nature.  Under 
the  apprehension  of  posthumous  degradation, 
human  bodies  have  been  embalmed,  their  con- 
centrated dust  has  been  inclosed  in  golden  urns, 
monumental  fortresses  have  been  piled  over  their 


180  ON   THE   BURIAL 

decaying  bones ;  with  what  success,  and  with 
what  use,  it  may  not  be  amiss  to  consider. 

I  have  selected  a  few  instances,  in  which  meas- 
ures have  been  taken  to  protect  the  human  frame 
from  decay,  which  will  be  seen  to  have  been  in 
some  cases  partially  successful,  in  others  not  so. 
They  will  serve  as  preliminaries  to  the  general 
considerations  which  are  connected  with  the 
subject. 

One  of  the  most  interesting  accounts  of  the 
preservation  of  a  body,  the  identity  of  which  was 
undoubted,  is  that  of  the  disinterment  of  King 
Edward  I.  of  England.  The  readers  of  English 
history  will  recollect  that  this  monarch  gave,  as 
a  dying  charge  to  his  son,  that  his  heart  should 
be  sent  to  the  Holy  Land,  but  that  his  body 
should  be  carried  in  the  van  of  the  army  till 
Scotland  was  reduced  to  obedience. 

He  died  in  July,  1307,  and,  notwithstanding  his 
injunctions,  was  buried  in  Westminster  Abbey  in 
October  of  the  same  year.  It  is  recorded  that  he 
was  embalmed,  and  orders  for  renewing  the  cere- 
cloth about  his  body  were  issued  in  the  reigns 
of  Edward  III.  and  Henry  IV.  The  tomb  of  this 
monarch  was  opened,  and  his  body  examined  in 


OF   THE   DEAD.  181 

January,  1774,  under  the  direction  of  Sir  Joseph 
Ayloffe,  after  it  had  been  buried  four  hundred 
and  sixty-seven  years.  The  following  account  is 
extracted  from  a  contemporaneous  volume  of  the 
Gentleman's  Magazine. 

"  Some  gentlemen  of  the  Society  of  Antiqua- 
ries, being  desirous  to  see  how  far  the  actual 
state  of  Edward  First's  body  answered  to  the 
methods  taken  to  preserve  it,  obtained  leave  to 
open  the  large  stone  sarcophagus,  in  which  it  is 
known  to  have  been  deposited,  on  the  north  side 
of  Edward  the  Confessor's  chapel.  This  was 
accordingly  done  on  the  morning  of  January  2, 
1774,  when  in  a  coffin  of  yellow  stone  they  found 
the  royal  body  in  perfect  preservation,  inclosed 
in  two  wrappers  ;  one  of  them  was  of  gold  tissue, 
strongly  waxed,  and  fresh,  the  other  and  outer- 
most considerably  decayed.  The  corpse  was 
habited  in  a  rich  mantle  of  purple,  paned  with 
white,  and  adorned  with  ornaments  of  gilt  metal, 
studded  with  red  and  blue  stones  and  pearls. 
Two  similar  ornaments  lay  on  the  hands.  The 
mantle  was  fastened  on  the  right  shoulder  by  a 
magnificent  fibula  of  the  same  metal,  with  the 
16 


182  ON  THE  BUKIAL 

same  stones  and  pearls.  His  face  had  over  it  a 
silken  covering,  so  fine,  and  so  closely  fitted  to 
it,  as  to  preserve  the  features  entire.  Round  his 
temples  was  a  gilt  coronet  of  fleurs  de  lys.  In 
his  hands,  which  were  also  entire,  were  two 
sceptres  of  gilt  metal ;  that  in  the  right  sur- 
mounted by  a  cross  fleure,  that  in  the  left  by 
three  clusters  of  oak  leaves,  and  a  dove  on  a 
globe;  this  sceptre  was  about  five  feet  long.  The 
feet  were  enveloped  in  the  mantle  and  other  cov-* 
erings,  but  sound,  and  the  toes  distinct.  The 
whole  length  of  the  corpse  was  five  feet  two 
inches." 

This  last  statement,  it  will  be  observed,  is  the 
only  point  in  which  the  narrative  appears  to  dis- 
agree with  history.  We  are  generally  given  to 
understand  that  Edward  I.  was  a  tall  man ;  and 
that  he  was  designated  in  his  own  time  by  the 
name  of  Long-shanks.  Baker,  in  his  Chronicle 
of  the  Kings  of  England,  says  of  him  that  he  was 
tall  of  stature,  exceeding  most  other  men  by  a 
head  and  shoulders.  I  have  not  been  able  to  find 
Sir  Joseph  Ayloffe's  account  of  the  examination, 
and  know  of  no  other  mode  of  reconciling  the 


OF   THE   DEAD.  183 

discrepancy,  but  by  supposing  a  typographical 
error  of  a  figure  in  the  account  which  has  been 
quoted. 

Edward  I.  died  at  Burgh-upon-Sands,  in  Cum- 
berland, on  his  way  to  Scotland,  July  7,  1307,  in 
.the  sixty-eighth  year  of  his  age. 

Another  instance  of  partial  preservation  is  that 
of  the  body  of  King  Charles  I.,  who  was  beheaded 
by  his  subjects  in  1649.  The  remains  of  this  un- 
fortunate monarch  are  known  to  have  been  car- 
ried to  Windsor,  and  there  interred  by  his  friends 
without  pomp,  in  a  hasty  and  private  manner.  It 
is  stated  in  Clarendon's  History  of  the  Rebellion, 
that  when  his  son,  Charles  II.,  was  desirous  to 
remove  and  remter  his  corpse  at  Westminster 
Abbey,  it  could  not  by  any  search  be  found.  In 
constructing  a  mausoleum  at  Windsor,  in  1813, 
under  the  direction  of  George  IV.,  then  Prince 
Regent,  an  accident  led  to  the  discovery  of  this 
royal  body.  The  workmen,  in  forming  a  subter- 
raneous passage  under  the  choir  of  St.  George's 
Chapel,  accidentally  made  an  aperture  in  the  wall 
of  the  vault  of  King  Henry  VIII.  On  looking 
through  this  opening  it  was  found  to  contain 
three  coffins,  instead  of  two,  as  had  been  sup- 


184  ON   THE  BURIAL 

posed.  Two  of  these  were  ascertained  to  be  the 
coffins  of  Henry  VIII.,  and  of  one  of  his  queens, 
Jane  Seymour.  The  other  was  formally  exam- 
ined, after  permission  obtained,  by  Sir  Henry 
Halford,  in  presence  of  several  members  of  the 
royal  family,  and  other  persons  of  distinction. 
The  account  since  published  by  Sir  Henry,  cor- 
roborates the  one  which  had  been  given  by  Mr. 
Herbert,  a  groom  of  King  Charles'  bedchamber, 
and  is  published  in  Wood's  Athenas  Oxonienses. 

"  On  removing  the  pall,"  says  the  account,  "  a 
plain  leaden  coffin  presented  itself  to  view,  with 
no  appearance  of  ever  having  been  inclosed  in 
wood,  and  bearing  an  inscription,  '  King  Charles, 
1648,'  in  large,  legible  characters,  on  a-  scroll  of 
lead  encircling  it.  A  square  opening  was  then 
made  in  the  upper  part  of  the  lid,  of  such  dimen- 
sions as  to  admit  a  clear  insight  into  its  contents. 
These  were,  an  internal  wooden  coffin,  very  much 
decayed,  and  the  body  carefully  wrapped  up  in 
cerecloth,  into  the  folds  of  which  a  quantity  of 
unctuous  matter,  mixed  with  resin,  as  it  seemed, 
had  been  melted,  so  as  to  exclude,  as  effectually 
as  possible,  the  external  air.  The  coffin  was  com- 


OF   THE   DEAD.  185 

pletely  full,  and,  from  the  tenacity  of  the  cere- 
cloth, great  difficulty  was  experienced  in  detach- 
ing it  successfully  from  the  parts  which  it  envel- 
oped. Wherever  the  unctuous  matter  had  insin- 
uated itself,  the  separation  of  the  cerecloth  was 
easy;  and,  where  it  came  off,  a  correct  impression 
of  the  features  to  which  it  had  been  applied  was 
observed.  At  length  the  whole  face  was  disen- 
gaged from  its  covering.  The  complexion  of  the 
skin  of  it  was  dark  and  discolored.  The  forehead 
and  temples  had  lost  little  or  nothing  of  their 
muscular  substance  ;  the  cartilage  of  the  nose 
was  gone  ;  but  the  left  eye,  in  the  first  moment 
of  exposure,  was  open  and  full,  though  it  van- 
ished almost  immediately;  and  the  pointed  beard, 
so  characteristic  of  the  period  of  the  reign  of 
King  Charles,  was  perfect.  The  shape  of  the 
face  was  a  long  oval ;  many  of  the  teeth  re- 
mained ;  and  the  left  ear,  in  consequence  of  the 
interposition  of  the  unctuous  matter  between  it 
and  the  cerecloth,  was  found  entire. 

"  It  was  difficult,  at  this  moment,  to  withhold  a 
declaration,  that,  notwithstanding   its   disfigure- 
ment, the  countenance  did  bear  a  strong  resem- 
blance to  the  coins,  the  busts,  and  especially  to 
16* 


186  ON  THE  BURIAL 

the  picture  of  King  Charles  the  First,  by  Van- 
dyke, by  which  it  had  been  made  familiar  to  us. 
It  is  true  that  the  minds  of  the  spectators  of  this 
interesting  sight  were  well  prepared  to  receive 
this  impression ;  but  it  is  also  certain  that  such  a 
facility  of  belief  had  been  occasioned  by  the  sim- 
plicity and  truth  of  Mr.  Herbert's  Narrative,  every 
part  of  which  had  been  confirmed  by  the  investi- 
gation, so  far  as  it  had  advanced ;  and  it  will  not 
be  denied  that  the  shape  of  the  face,  the  forehead, 
the  eye,  and  the  beard,  are  the  most  important 
features  by  which  resemblance  is  determined. 

"  When  the  head  had  been  entirely  disengaged 
from  the  attachments  which  confined  it,  it  was 
found  to  be  loose,  and  without  any  difficulty  was 
taken  out  and  held  up  to  view.  The  back  part 
of  the  scalp  was  entirely  perfect,  and  had  a  re- 
markably fresh  appearance ;  the  pores  of  the  skin 
being  more  distinct,  and  the  tendons  and  liga- 
ments of  the  neck  were  of  considerable  substance 
and  firmness.  The  hair  was  thick  at  the  back  part 
of  the  head,  and  in  appearance  nearly  black.  A 
portion  of  it,  which  has  since  been  cleaned  and 
dried,  is  of  a  beautiful  dark  brown  color.  That 
of  the  beard  was  a  redder  brown.  On  the  back 


OF   THE   DEAD.  187 

part  of  the  head  it  was  not  more  than  an  inch  in 
length,  and  had  probably  been  cut  so  short  for 
the  convenience  of  the  executioner,  or  perhaps  by 
the  piety  of  friends  soon  after  death,  in  order  to 
furnish  memorials  of  the  unhappy  king. 

"  On  holding  up  the  head  to  examine  the  place 
of  separation  from  the  body,  the  muscles  of  the 
neck  had  evidently  retracted  themselves  consider- 
ably ;  and  the  fourth  cervical  vertebra  was  found 
to  be  cut  through  its  substance  transversely,  leav- 
ing the  surfaces  of  the  divided  portions  perfectly 
smooth  and  even, —  an  appearance  which  could 
have  been  produced  only  by  a  heavy  blow,  in- 
flicted with  a  very  sharp  instrument,  and  which 
furnished  the  last  proof  wanting  to  identify  King 
Charles  the  First." 

The  foregoing  are  two  of  the  most  successful 
instances  of  posthumous  preservation.  The  care 
taken  in  regard  to  some  other  distinguished  per- 
sonages has  been  less  fortunate  in  its  result.  The 
coffin  of  Henry  VIII.  was  inspected  at  the  same 
time  with  that  of  Charles,  and  was  found  to  con- 
tain nothing  but  the  mere  skeleton  of  that  king. 
Some  portions  of  beard  remained  on  the  chin, 


188  ON  THE   BURIAL 

but  there  was  nothing  to  discriminate  the  person- 
age contained  in  it. 

During  the  present  century,  the  sarcophagus 
of  King  John  has  also  been  examined.  It  con- 
tained little  else  than  a  disorganized  mass  of 
earth.  The  principal  substances  found  were  some 
half-decayed  bones,  a  few  vestiges  of  cloth  and 
leather,  and  a  long  rusty  piece  of  iron,  apparently 
the  remains  of  the  sword-blade  of  that  monarch. 

The  rapidity  with  which  decomposition  takes 
place  in  organic  bodies  depends  upon  the  partic- 
ular circumstances  under  which  they  are  placed. 
A  certain  temperature  and  a  certain  degree  of 
moisture  are  indispensable  agents  in  the  com- 
mon process  of  putrefaction,  and,  could  these  be 
avoided  in  the  habitable  parts  of  our  globe,  hu- 
man bodies  might  last  indefinitely.  I  shall  be  ex- 
cused for  dwelling  a  short  time  on  the  influence 
of  some  of  these  preservative  agents.  Where  a 
certain  degree  of  cold  exists,  it  tends  powerfully 
to  check  the  process  of  destructive  fermentation, 
and,  when  it  extends  so  far  as  to  produce  congel- 
ation, its  protecting  power  is  complete.  Bodies 
of  men  and  animals  are  found  in  situations  where 
they  have  remained  frozen  for  years,  and  even 


OF   THE   DEAD.  189 

for  ages.  Not  many  years  ago,  the  bodies  of 
some  Spanish  soldiers  were  found  in  a  state  of 
perfect  preservation  among  the  snows  of  the 
Andes,  where  they  were  supposed  to  have  per- 
ished in  attempting  to  cross  those  mountains, 
nearly  a  century  ago ;  their  costume  and  some 
historical  records  indicating  the  probable  period 
of  their  expedition.  At  the  Hospice  of  the  Grand 
St.  Bernard  in  the  Alps,  some  receptacles  of  the 
dead  are  shown  to  travellers,  in  which,  owing  to 
the  effect  of  perpetual  frost,  together  with  the 
lightness  of  the  atmosphere,  but  little  absolute 
decay  has  taken  place  in  the  subjects  deposited 
during  a  lapse  of  years.  But  the  most  remarka- 
ble instance  of  preservation  by  frost  of  an  animal 
body,  is  that  of  an  elephant,  of  an  extinct  species, 
discovered  in  1806  in  the  ice  of  the  polar  sea, 
near  the  mouth  of  the  river  Lena,  by  Mr.  Michael 
Adams.  This  animal  was  first  seen  by  a  chief  of 
the  Tonguse  tribe,  in  the  year  1799,  at  which  time 
it  was  imbedded  in  a  rock  of  ice  about  one  hun- 
dred and  eighty  feet  high,  and  had  only  two  feet, 
with  a  small  part  of  the  body,  projecting  from  the 
side,  so  as  to  be  visible.  At  the  close  of  the  next 
summer,  the  entire  flank  of  the  animal  had  been 


190  ON   THE   BURIAL 

thawed  out.  It  nevertheless  required  five  sum- 
mers, in  this  inclement  region,  to  thaw  the  ice  so 
that  the  whole  body  could  be  liberated.  At 
length,  in  1804,  the  enormous  mass  separated 
from  the  mountain  of  ice,  and  fell  over  upon  its 
side,  on  a  sand-bank.  At  this  time  it  appears  to 
have  been  in  a  state  of  perfect  preservation,  with 
its  skin  and  flesh  as  entire  as  when  it  had  existed 
antecedently  to  the  deluge,  or  during  that  con- 
dition of  the  globe  which  placed  animals  appar- 
ently of  the  torrid  zone  in  the  confines  of  the 
Arctic  circle.  The  Tonguse  chief  cut  off  the 
tusks,  which  were  nine  feet  long,  and  weighed 
two  hundred  pounds  each.  Two  years  after  this 
event,  Mr.  Adams,  being  at  Yakutsk,  and  hearing 
of  this  event,  undertook  a  journey  to  the  spot. 
He  found  the  animal  in  the  same  place,  but  ex- 
ceedingly mutilated  by  the  dogs  and  wolves  of 
the  neighborhood,  which  had  fed  upon  its  flesh 
as  fast  as  it  thawed.  He,  however,  succeeded  in 
removing  the  whole  skeleton,  and  in  recovering 
two  of  the  feet,  one  of  the  ears,  one  of  the  eyes, 
and  about  three  quarters  of  the  skin,  which  was 
covered  with  reddish  hair  and  black  bristles. 
These  are  now  in  the  museum  at  St.  Petersburg. 


OP   THE  DEAD.  191 

The  foregoing  facts  are  sufficient  to  show  that 
a  low  degree  of  temperature  is  an  effectual  pre- 
ventive of  animal  decomposition.  On  the  other 
hand,  a  certain  degree  of  heat  combined  with  a 
dry  atmosphere,  although  a  less  perfect  protec- 
tion, is  sufficient  to  check  the  destructive  process. 
Warmth,  combined  with  moisture,  tends  greatly 
to  promote  decomposition ;  yet,  if  the  degree  of 
heat,  or  the  circumstances  under  which  it  acts, 
are  such  as  to  produce  a  perfect  dissipation  of 
moisture,  the  further  progress  of  decay  is  ar- 
rested. In  the  arid  caverns  of  Egypt  the  dried 
flesh  of  mummies,  although  greatly  changed  from 
its  original  appearance,  has  made  no  progress 
towards  ultimate  decomposition  during  two  or 
three  thousand  years.  It  is  known  that  the  an- 
cient Egyptians  embalmed  the  dead  bodies  of 
their  friends,  by  extracting  the  large  viscera  from 
the  cavities  of  the  head,  chest  and  abdomen,  and 
filling  them  with  aromatic  and  resinous  sub- 
stances, particularly  asphaltum,  and  enveloping 
the  outside  of  the  body  in  cloths  impregnated 
with  similar  materials.  These  impregnations  pre- 
vented decomposition  for  a  time,  until  perfect 
dryness  had  taken  place.  Their  subsequent  pres- 


192  ON   THE   BURIAL 

ervation,  through  so  many  centuries,  appears  to 
have  been  owing,  not  so  much  to  the  antiseptic 
quality  of  the  substance  in  which  they  are  envel- 
oped, as  to  the  effectual  exclusion  of  moisture. 

In  the  crypt  under  the  cathedral  of  Milan  travel- 
lers are  shown  the  ghastly  relics  of  Carlo  Borro- 
meo,  as  they  have  lain  for  two  centuries,  inclosed 
in  a  crystal  sarcophagus,  and  bedecked  with  cost- 
ly finery  of  silk  and  gold.  The  preservation  of 
this  body  is  equal  to  that  of  an  Egyptian  mummy, 
yet  a  more  loathsome  piece  of  mockery  than  it 
exhibits  can  be  hardly  imagined. 

It  will  be  perceived  that  the  instances  which 
have  been  detailed  are  cases  of  extraordinary  ex- 
emption, resulting  from  uncommon  care,  or  from 
the  most  favorable  combination  of  circumstances, 
such  as  can  befall  but  an  exceedingly  small  por- 
tion of  the  human  race.  The  common  fate  of 
animal  bodies  is  to  undergo  the  entire  destruc- 
tion of  their  fabric,  and  the  obliteration  of  their 
living  features  in  a  few  years,  and  sometimes 
even  weeks,  after  their  death.  No  sooner  does 
life  cease,  than  the  elements  which  constituted 
the  vital  body  become  subject  to  the  common 
laws  of  inert  matter.  The  original  affinities 


OP   THE   DEAD.  193 

which  had  been  modified  or  suspended  during 
life,  are  brought  into  operation,  the  elementary 
atoms  react  upon  each  other,  the  organized  struc- 
ture passes  into  decay,  and  is  converted  to  its 
original  dust.  Such  is  the  natural,  and,  I  may 
add,  the  proper  destination  of  the  material  part 
of  all  that  has  once  moved  and  breathed. 

The  reflections  which  naturally  suggest  them- 
selves, in  contemplating  the  wrecks  of  humanity 
which  have  occasionally  been  brought  to  light, 
are  such  as  lead  us  to  ask,  of  what  possible  use 
is  a  resistance  to  the  laws  of  nature,  which,  when 
most  successfully  executed,  can  at  best  only  pre- 
serve a  defaced  and  degraded  image  of  what  was 
once  perfect  and  beautiful  ?  Could  we,  by  any 
means,  arrest  the  progress  of  decay,  so  as  to 
gather  round  us  the  dead  of  a  hundred  genera- 
tions in  a  visible  and  tangible  shape,  —  could  we 
fill  our  houses  and  our  streets  with  mummies,  — 
what  possible  acquisition  could  be  more  useless, 
what  custom  could  be  more  revolting?  For  pre- 
cisely the  same  reason,  the  subterranean  vaults 
and  the  walls  of  brick,  which  we  construct  to 
divide  the  clay  of  humanity  from  that  of  the  rest 
of  creation,  and  to  preserve  it  separate  for  a  time, 
17 


194  ON   THE   BURIAL 

as  it  were  for  future  inspection,  are  neither  use- 
ful, gratifying,  nor  ultimately  effectual.  Could 
the  individuals  themselves,  who  are  to  be  the 
subjects  of  this  care,  have  the  power  to  regulate 
the  officious  zeal  of  their  survivors,  one  of  the 
last  things  they  could  reasonably  desire  would 
be  that  the  light  should  ever  shine  on  their 
changed  and  crumbling  relics. 

On  the  other  hatid,  when  nature  is  permitted 
to  take  its  course,  when  the  dead  are  committed 
to  the  earth  under  the  open  sky,  to  become  early 
and  peacefully  blended  with  their  original  dust, 
no  unpleasant  association  remains.  It  would 
seem  as  if  the  forbidding  and  repulsive  condi- 
tions which  attend  on  decay  were  merged  and 
lost  in  the  surrounding  harmonies  of  the  creation. 

When  the  body  of  Major  Andre  was  taken  up, 
a  few  years  since,  from  the  place  of  its  interment 
near  the  Hudson,  for  the  purpose  of  being  re- 
moved to  England,  it  was  found  that  the  skull  of 
that  officer  was  closely  encircled  by  a  network, 
formed  by  the  roots  of  a  small  tree  which  had 
been  planted  near  his  head.  This  is  a  natural  and 
most  beautiful  coincidence.  It  would  seem  as  if 
a  faithful  sentinel  had  taken  his  post,  to  watch, 


OF  THE  DEAD.  195 

till  the  obliterated  ashes  should  no  longer  need  a 
friend.  Could  we  associate  with  inanimate  clay 
any  of  the  feelings  of  sentient  beings,  who  would 
not  wish  to  rescue  his  remains  from  the  prisons 
of  mankind,  and  commit  them  thus  to  the  embrace 
of  nature  ? 

Convenience,  health  and  decency  require  that 
the  dead  should  be  early  removed  from  our  sight. 
The  law  of  nature  requires  that  they  should 
moulder  into  dust,  and  the  sooner  this  change  is 
accomplished,  the  better.  This  change  should 
take  place,  not  in  the  immediate  contiguity  of 
survivors,  not  in  frequented  receptacles  provided 
for  the  promiscuous  concentration  of  numbers, 
not  where  the  intruding  light  may  annually  usher 
in  a  new  tenant  to  encroach  upon  the  old.  It 
should  take  place  peacefully,  silently,  separately, 
in  the  retired  valley,  or  the  sequestered  wood, 
where  the  soil  continues  its  primitive  exuber- 
ance, and  where  the  earth  has  not  become  too 
costly  to  afford  to  each  occupant  at  least  his 
length  and  breadth. 

Within  the  bounds  of  populous  and  growing 
cities,  interments  cannot  with  propriety  take 
place  beyond  a  limited  extent.  The  vacant  tracts 


196  ON  THE  BURIAL 

reserved  for  burial-grounds,  and  the  cellars  of 
churches  which  are  converted  into  tombs,  be- 
come glutted  with  inhabitants,  and  are  in  the  end 
obliged  to  be  abandoned,  though  not  perhaps  un- 
til the  original  tenants  have  been  ejected,  and  the 
same  space  has  been  occupied  three  or  four  suc- 
cessive times.  Necessity  obliges  a  recourse  at 
last  to  be  had  to  the  neighboring  country,  and 
hence  in  Paris,  London,  Liverpool,  Leghorn,  and 
other  European  cities,  cemeteries  have  been  con- 
structed without  the  confines  of  their  population. 
These  places,  in  consequence  of  the  sufficiency 
of  the  ground,  and  the  funds  which  usually  grow 
out  of  such  establishments,  have  been  made  the 
recipients  of  tasteful  ornament.  Travellers  are 
attracted  by  their  beauty,  and  dwell  with  interest 
on  their  subsequent  recollection.  The  scenes 
which,  under  most  other  circumstances,  are  re- 
pulsive and  disgusting,  are  by  the  joint  influence 
of  nature  and  art  rendered  beautiful,  attractive, 
and  consoling. 

The  situation  of  Mount  Auburn,  near  Boston, 
is  one  of  great  natural  fitness  for  the  objects  to 
which  it  has  been  devoted.  Independently  of 
its  superior  size,  it  may  be  doubted  whether  any 


OF   THE   DEAD.  197 

spot,  which  has  been  set  apart  for  the  same  pur- 
poses in  Europe,  possesses  half  the  interest  in  its 
original  features.  In  a  few  years,  when  the  hand 
of  taste  shall  have  scattered  among  the  trees,  as 
it  has  already  begun  to  do,  enduring  memorials 
of  marble  and  granite,  a  landscape  of  the  most 
picturesque  character  will  be  created.  No  place 
in  the  environs  of  our  city  will  possess  stronger 
attractions  to  the  visitor.  To  the  mourner  it 
offers  seclusion  amid  the  consoling  influences  of 
nature.  The  moralist  and  man  of  religion  will 

"  Find  room 

And  food  for  meditation,  nor  pass  by 
Much,  that  may  give  him  pause,  if  pondered  fittingly." 

We  regard  the  relics  of  our  deceased  friends 
and  kindred  for  what  they  have  been,  and  not 
for  what  they  are.  We  cannot  keep  in  our  pres- 
ence the  degraded  image  of  the  original  frame  ; 
and  if  some  memorial  is  necessary  to  soothe  the 
unsatisfied  want  which  we  feel  when  bereaved 
of  their  presence,  it  must  be  found  in  contem- 
plating the  place  in  which  we  know  that  their 
dust  is  hidden.  The  history  of  mankind,  in  all 
ages,  shows  that  the  human  heart  clings  to  the 
17* 


198       ON  THE  BURIAL  OF  THE  DEAD. 

grave  of  its  disappointed  wishes,  that  it  seeks 
consolation  in  rearing  emblems  and  monuments, 
and  in  collecting  images  of  beauty  over  the  dis- 
appearing relics  of  humanity.  This  can  be  fitly 
done,  not  in  the  tumultuous  and  harassing  din  of 
cities,  not  in  the  gloomy  and  almost  unapproach- 
able vaults  of  charnel-houses ;  but  amidst  the 
quiet  verdure  of  the  field,  under  the  broad  and 
cheerful  light  of  heaven,  where  the  harmonious 
and  ever-changing  face  of  nature  reminds  us,  by 
its  resuscitating  influences,  that  to  die  is  but  to 
live  again. 


ON    THE 


DEATH  OF  PLINY  THE  ELDER. 


[From  the  Memoirs  of  the  American  Academy  of  Arts  and  Sciences,  vol.  vi.] 

IT  is  commonly  represented  by  authors  and 
compilers  that  Pliny  the  elder,  who  died  during 
an  eruption  of  Vesuvius  in  the  year  of  Christ  79, 
perished  by  suffocation  from  the  exhalations  of 
the  volcano ;  and  a  great  preciseness  of  expres- 
sion on  this  subject  has  been  perpetuated  by 
most  writers  who  have  touched  upon  it  in  mod- 
ern times. 

In  the  preface  of  Broterius  to  the  Life  and 
Writings  of  Pliny,  it  is  said :  "  Flammis  et  flam- 
marum  prsemmtio  odore  sulphuris  exanimatus 
est."  Mason,  in  Smith's  Greek  and  Roman  Biog- 
raphy, says  :  "  He  almost  immediately  dropped 
down,  suffocated,  as  his  nephew  conjectures,  by 
the  vapors."  In  Lempriere's  Classical  Diction- 


200  ON   THE   DEATH   OF 

ary  the  same  is  stated :  "  He  soon  fell  down, 
suffocated  by  the  thick  vapors  that  surrounded 
him."  Rees'  Cyclopaedia,  art.  PLIXY,  has  a  sim- 
ilar statement :  "  In  his  flight  he  was  suffocated, 
being  then  in  the  fifty-sixth  year  of  his  age." 
Cuvier,  in  the  Biographic  Universelle,  thus  par- 
ticularizes the  closing  scene  :  "  Deux  esclaves 
seulement  resterent  aupres  du  malheureux  Pline, 
qui  perit  suffoque,  par  les  cendres  et  par  les  exha- 
laisons  sulfureuses  du  volcan."  Simond,  in  his 
Tour  in  Italy,  says  of  Pliny  at  Stabiee :  "Although 
not  much  nearer  to  Vesuvius  than  Naples  is, 
he  there  met  his  death,  from  mere  suffocation 
probably,  as  his  body  was  afterwards  found  ex- 
ternally uninjured."  Sir  Charles  Lyell,  in  his 
Principles  of  Geology,  says  of  Pliny :  "  In  his 
anxiety  to  obtain  a  nearer  view  of  the  phenom- 
ena, he  lost  his  life,  being  suffocated  by  sulphu- 
reous vapors." 

The  only  authentic  and  contemporaneous  nar- 
rative extant  of  the  death  of  Pliny,  and  that 
on  which  subsequent  opinions  are  necessarily 
founded,  is  that  contained  in  the  letter  of  his 
nephew,  Pliny  the  younger.  After  an  examina- 
tion of  this  celebrated  epistle,  it  appears  to  me 


PLINY   THE   ELDER.  201 

highly  probable  that  the  elder  Pliny  got  his 
death  not  from  suffocation  or  asphyxia,  as  is 
commonly  believed,  but  from  some  more  specific 
and  natural  disease.  The  following  is  a  part  of 
the  translation  by  Mr.  Melmoth  of  this  epistle  : 

"  In  the  mean  while,  the  fire  from  Vesuvius 
flamed  forth  from  several  parts  of  the  mountain 
with  great  violence,  which  the  darkness  of  the 
night  contributed  to  render  still  more  visible  and 
dreadful.  But  my  uncle,  in  order  to  calm  the 
apprehensions  of  his  friend,  assured  him  that  it 
was  only  the  conflagration  of  the  villages  which 
the  country  people  had  abandoned.  After  this, 
he  retired  to  rest,  and  it  is  most  certain  he  was 
so  little  discomposed  as  to  fall  into  a  deep  sleep ; 
for,  being  corpulent  and  breathing  hard,  the  at- 
tendants in  the  antechamber  actually  heard  him 
snore.  The  court  which  led  to  his  apartment 
being  now  almost  filled  with  stones  and  ashes,  it 
would  have  been  impossible  for  him,  if  he  had 
continued  there  any  longer,  to  have  made  his 
way  out.  It  was  thought  proper,  therefore,  to 
awaken  him.  He  got  up,  and  joined  Pompom- 
anus  and  the  rest  of  the  company,  who  had  not 


202 


been  sufficiently  unconcerned  to  think  of  going 
to  bed.  They  consulted  together  whether  it 
would  be  most  prudent  to  trust  to  the  houses, 
which  now  shook  from  side  to  side  with  frequent 
and  violent  concussions,  or  flee  to  the  open  fields, 
where  the  calcined  stones  and  cinders,  though 
levigated  indeed,  yet  fell  in  large  showers,  and 
threatened  them  with  instant  destruction.  In 
this  distress,  they  resolved  upon  the  fields,  as 
the  less  dangerous  situation  of  the  two  ;  a  reso- 
lution which,  while  the  rest  of  the  company  were 
hurried  into  by  their  fears,  my  uncle  embraced 
upon  cool  and  deliberate  consideration.  They 
went  out  then,  having  pillows  tied  upon  their 
heads  with  napkins  ;  and  this  was  their  whole 
defence  against  the  storm  of  stones  which  fell 
around  them.  It  was  now  day  everywhere  else, 
but  there  a  deeper  darkness  prevailed  than  in  the 
blackest  night,  which,  however,  was  in  some  de- 
gree dissipated  by  torches  and  other  lights  of 
various  l£inds.  They  thought  it  expedient  to  go 
down  further  upon  the  shore,  in  order  to  observe 
if  they  might  safely  put  out  to  sea ;  but  they 
found  the  waves  still  running  extremely  high  and 
boisterous.  There  my  uncle,  having  drunk  a 


PLINY   THE   ELDER.  203 

draught  or  two  of  cold  water,  laid  himself  down 
upon  a  sail-cloth  which  was  spread  for  him  ; 
when  immediately  the  flames,  preceded  by  a 
strong  smell  of  sulphur,  dispersed  the  rest  of  the 
company  and  obliged  him  to  rise.  He  raised 
himself  up  with  the  assistance  of  two  of  his  ser- 
vants, and  instantly  fell  down  dead,  suffocated,  I 
conjecture,  by  some  gross  and  noxious  vapor, 
having  always  had  weak  lungs,  and  being  fre- 
quently subject  to  a  difficulty  of  breathing." 

Notwithstanding  the  elegance  and  general  ac- 
curacy of  Mr.  Melmoth's  translation,  there  is 
room  for  doubting  the  exactness  of  that  part 
which  contains  the  closing  scene  of  Pliny's  life. 
The  words  of  the  younger  Pliny  are  as  follows  : 
"  Deinde  flammse,  flammarumque  prsenuntius  odor 
sulfuris,  alios  in  fugam  vertunt,  excitant  ilium. 
Innixus  servis  duobus  adsurrexit,  et  statim  con- 
cidit,  ut  ego  conjecto  crassiore  caligine  spiritu 
obstructo,  clausoque  stomacho,  qui  illi  natura 
invalidus  et  angustus  et  frequenter  intersestuans 
erat."  The  more  exact  translation  of  this  pas- 
sage would  be  as  follows  :  "  Then  the  flames  and 
the  odor  of  sulphur  premonitory  of  the  flames 


204  ON   THE   DEATH   OF 

put  the  others  to  flight  and  aroused  him.  He 
rose,  leaning  upon  two  slaves,  and  immediately 
-fell  dead,  his  breath  being  obstructed,  as  I  con- 
jecture, by  the  thick  mist  (caligine),  and  his 
stomach  being  shut  up,  which  in  him  was  by. 
nature  weak,  narrow,  and  subject  to  frequent 
commotion."  The  fact  here  is  that  he  fell  sud- 
denly dead.  The  theory  of  Pliny,  his  nephew, 
who  was  not  present,  and  who  was  not  much 
versed  in  anatomy,  is,  that  he  died  from  obstruc- 
tion of  his  breath  by  the  "  caligo ; "  a  word  which 
means  darkness,  fog,  mist,  also  metaphorically 
blindness,  dizziness,  and  ignorance,  but  does  not 
mean  a  noxious  or  irrespirable  vapor. 

That  this  "  caligo  "  was  not  composed  of  mate- 
rials necessarily  destructive  of  life,  there  is 
abundant  collateral  evidence.  Pliny  had  been 
attended  to  the  spot  by  a  considerable  party,  and 
two  slaves  were  actually  supporting  him  at  the 
time  of  his  death.  Yet  it  does  not  appear  from 
record  that  any  of  these  persons  suffered  death 
or  detriment  from  the  inhalation  of  noxious  gas 
on  the  occasion.  The  character  of  the  "  caligo  " 
is  further  elucidated  by  the  personal  experience 
of  the  younger  Pliny,  who  witnessed  its  effects 


PLINY  THE   ELDER.  205 

during  the  same  eruption,  and  has  described  its 
phenomena  in  a  subsequent  letter,  the  nephew 
being  at  Misenum,  while  the  uncle  was  at  Stabias, 
in  the  same  vicinity  to  the  mountain  : 

"  It  was  now  morning,  but  the  light  was  ex- 
ceedingly faint  and  languid.  The  buildings  all 
around  us  tottered,  and  though  we  stood  upon 
open  ground,  yet,  as  the  place  was  narrow  and 
confined,  there  was  no  remaining  without  immi- 
nent danger.  We  therefore  resolved  to  leave 
the  town.  The  people  followed  us  in  the  utmost 
consternation,  and  pressed  in  great  crowds  about 
us  in  our  way  out.  Being  advanced  at  a  conven- 
ient distance  from  the  houses,  we  stood  still  in 
the  midst  of  a  most  hazardous  and  tremendous 
scene.  The  chariots  which  we  had  ordered  to 
be  drawn  out  were  so  agitated  backwards  and 
forwards,  though  upon  the  most  level  ground, 
that  we  could  not  keep  them  steady  even  by 
supporting  them  with  large  stones.  The  sea 
seemed  to  roll  back  upon  itself,  and  to  be  driven 
from  its  banks  by  the  convulsive  motion  of  the 
earth.  On  the  other  side,  a  black  and  dreadful 
cloud,  bursting  with  an  igneous,  serpentine  va- 
18 


206  ON  THE   DEATH   OP 

por,  darted  out  a  long  train  of  fire  resembling 

flashes  of  lightning Soon  afterwards 

the  cloud  seemed  to  descend  and  cover  the  whole 
ocean,  as  indeed  it  entirely  hid  the  island  of  Ca- 

prea  and  the  promontory  of  Misenum 

"  The  ashes  now  began  to  fall  upon  us,  though 
in  no  great  quantity.  I  turned  my  head,  and 
observed  behind  us  a  thick  smoke,  which  came 
rolling  after  us  like  a  torrent.  I  proposed,  while 
we  had  yet  any  light,  to  turn  out  of  the  high 
road,  lest  [we]  should  be  pressed  to  death  in  the 
dark  by  the  crowd  that  followed  us.  We  had 
scarcely  stepped  out  of  the  path  when  the  dark- 
ness overspread  us,  not  like  that  of  a  cloudy 
night,  or  when  there  is  no  moon,  but  of  a  room 
when  it  is  shut  up  and  all  the  lights  extinct. 
Nothing  then  was  to  be  heard  but  the  shrieks  of 
women,  the  screams  of  children,  and  the  cries  of 
men,  some  calling  for  their  children,  others  for 
their  parents,  others  for.  their  husbands,  and  only 
distinguishing  each  other  by  their  voices,  one 
lamenting  his  own  fate,  another  that  of  his  fam- 
ily, some  wishing  to  die  from  the  very  fear  of 

dying At  length  a  glimmering  light 

appeared, then  again  we  were  immersed 


PLKY   THE   ELDER.  207 

in  thick  darkness,  and  a  heavy  shower  of  ashes 
rained  upon  us,  which  we  were  obliged  every 
now  and  then  to  shake  off,  otherwise  we  should 
have  been  overwhelmed  and  buried  in  the  heap. 

At  last  this  terrible  darkness  [caligo] 

was  dissipated  by  degrees,  like  a  cloud  or  smoke, 
the  real  day  returned,  and  even  the  sun  appeared, 
though  very  faintly,  as  when  an  eclipse  is  coming 
on.  Every  object  that  presented  itself  to  our 
eyes  seemed  changed,  being  covered  with  white 
ashes,  as  with  a  deep  snow." 

From  these  descriptions  we  are  justified  in 
believing  that  the  "  caligo  "  which  pervaded  the 
air  during  this  eruption  of  Vesuvius  was  simply 
the  darkness  or  dark  haze  existing  in  an  atmos- 
phere rendered  nearly  opaque  by  falling  ashes. 
These  ashes  (cinis)  appear  to  have  consisted 
mainly  of  particles  of  solid  substance,  thrown 
out  from  the  crater,  or  sublimed  in  the  volcano 
and  condensed  in  the  atmosphere,  such  as  now 
cover  the  ruins  of  Pompeii.  As  to  the  "odor 
sulfuris,"  mentioned  in  the  first  letter,  it  is  not 
spoken  of  as  a  thing  in  itself  deleterious,  but 
merely  as  the  forerunner  (prsenuntius)  of  the 


208  ON   THE   DEATH    OF 

flames.  Had  the  air  been  highly  charged  with 
sulphurous  or  hydrosulphuric  acids,  which  are 
among  the  gaseous  products  of  volcanoes,  or 
even  with  the  sublimed  chlorides  more  common 
among  volcanic  gases,  it  is  hardly  probable  that 
Pliny  would  have  been  the  only  sufferer  on  the 
occasion,  or  that  eye-witnesses  would  have  sur- 
vived to  be  narrators  of  a  catastrophe  in  which 
they  themselves  had  no  share,  or  even  that  the 
inhabitants  of  Herculaneum  and  Pompeii,  which 
cities  were  buried  in  the  same  eruption  of  Vesu- 
vius, would  so  generally  have  escaped  as  they 
appear  to  have  done. 

The  important  facts  which  belong  to  the  ob- 
ject of  the  present  inquiry  may  be  summed  up 
briefly  as  follows :  Pliny  the  elder,  a  corpulent 
man,  subject  to  laborious  breathing  and  to  other 
infirmities  which  had  excited  the  notice,  if  not 
the  apprehensions,  of  his  friends,  was,  on  the  day 
and  night  preceding  his  death,  exposed  to  unu- 
sual fatigue  and  anxiety.  In  the  evening  lie  had 
had  himself  carried  to  a  bath,  ate  his  supper,  and 
went  to  bed,  where  he  slept  so  profoundly  as  to 
be  insensible  to  the  noise  and  danger  which  kept 
his  companions  awake.  At  length,  the  danger 


PLINY  THE  ELDEK.  209 

growing  more  imminent,  he  was  awakened,  and 
with  his  companions  fled  from  the  house,  the 
whole  company  carrying  pillows  on  their  heads 
to  ward  off  the  falling  stones.  In  this  way  they 
groped  their  way  through  the  darkness  till  the 
next  morning  (jam  dies  alibi,  illic  nox).  He  then 
lay  down  on  a  sail-cloth  spread  out  for  him,  —  a 
measure  which,  we  may  suppose,  would  hardly 
have  been  resorted  to  under  the  continuance  of 
danger  from  the  falling  stones,  except  from  want 
of  strength  on  his  part  to  proceed.  Neither  under 
the  same  circumstances  would  he  have  stopped 
repeatedly  to  demand  cold  water,  unless  suffer- 
ing unusual  thirst  (Semel  atque  iterum  frigidam 
poposcit  hausitque).  At  length,  under  a  fresh 
alarm,  he  raised  himself  up,  and  immediately  fell 
dead  while  leaning  upon  his  two  servants. 

A  medical  man  may  be  excused  for  believing 
that  Pliny  died  from  apoplexy  following  unusual 
exertion  and  excitement,  or  possibly  from  a  fatal 
crisis  in  some  disease  of  the  heart  previously 
existing. 

18* 


REMARKS  ON  PNEUMOTHORAX! 


WITH   CASES,    AND   AN    EXPERIMENTAL     INQUIRY     INTO    THE     CAUSES 
OF    THE   METALLIC    SOUNDS    HEARD    IN    TIIAT   DISEASE. 


[From  the  American  Journal  of  Medical  Sciences,  1839.] 

THE  sounds  which  are  heard  during  auscul- 
tation in  cases  of  pneumothorax,  especially 
when  life  has  been  prolonged  for  a  considerable 
time  under  the  disease,  have  a  character,  of 
which  the  term  metallic  is  eminently  descriptive. 
This  character  may  be  recognized  not  only  in 
the  respiration  and  cough,  but  frequently  also 
in  the  voice  and  the  succussion  and  percussion 
of  the  chest.  The  sound  is  either  sharp  and 
tinkling,  or  it  is  prolonged,  reverberating  and 
ringing,  according  to  the  kind  of  action  under 
which  it  is  produced.  In  both  cases  the  mechan- 
ical condition  of  the  chest  is  apparently  the 
same. 


REMARKS    ON   PNEUMOTHORAX.  211 

The  sounds  of  pneumothorax,  as  will  appear 
from  the  experiments  detailed  at  the  end  of  this 
article,  are  divisible,  with  relation  to  their  causes, 
into  those  of  impulse  and  those  of  reverbera- 
tion. The  first  requires  the  presence  of  liquid, 
the  second  may  take  place  with  only  the  pres- 
ence of  air.  The  first  includes  all  the  varieties 
of  metallic  tinkling  which  are  heard  in  respira- 
tion, which  also  take  place  after  speaking  and 
coughing,  and  which  may  be  abundantly  pro- 
duced in  many  cases  by  succussion  of  the  chest. 
When  well  developed  it  is  sharp,  silvery  and 
musical,  resembling  the  note  of  short  brass  wires 
in  certain  children's  toys.  The  second  class, 
that  of  reverberating  sounds,  includes  the  varie- 
ties of  amphoric  breathing,  and  may  be  imita-ted 
by  inflating  a  recent  bladder  to  a  considerable 
degree  of  tension  while  in  contact  with  the  ear, 
or  less  perfectly  by  blowing  into  a  glass  or  metal- 
lic vessel.  When  a  sudden  impetus  is  given  to 
it  by  coughing,  this  sound  becomes  more  intense, 
ringing  and  metallic.  The  voice  also  at  times 
acquires  the  metallic  resonance.  If  percussion 
be  performed  on  the  distended  chest,  while  the 
ear  is  applied  to  its  parietes,  a  ringing  sound  is 


212  EEMARKS   ON  PNEUMOTHORAX. 

communicated,  having  more  or  less  of  a  metallic 
character. 

Metallic  tinkling  of  the  chest,  although  one  of 
the  most  marked  of  the  physical  signs,  appears 
not  to  have  been  fully  explained  in  regard  to  the 
immediate  cause  by  which  it  is  produced.  Vari- 
ous hypothetical  solutions  have  at  different  times 
been  offered,  but  all  of  them  have  been  objected 
to,  or  seem  liable  to  objections,  on  the  score  of 
insufficiency ;  and  no  one  of  them  appears  at  this 
time  to  have  obtained  a  general  assent.  A  brief 
summary  is  sufficient  to  present  the  leading  feat- 
ures of  the  different  modes  in  which  this  phe- 
nomenon has  been  accounted  for. 

The  only  explanation  given  by  Laennec  of  this 
sound  is  by  him  considered  applicable  to  cases 
of  what  he  calls  simple  hydro-pneumothorax,  in 
which  there  is  no  communication  with  the  bron- 
chiae ;  a  form  of  the  disease,  however,  the  exist- 
ence of  which  has  been  doubted  by  some  subse- 
quent writers.  Laennec  says  that  if  a  patient 
happen  to  raise  himself  suddenly  in  bed,  and  a 
drop  of  fluid  fall  from  the  upper  part  of  the 
cavity  of  the  pleura  into  the  fluid  beneath,  it  pro- 
duces a  sound  like  that  occasioned  by  a  drop  of 


REMARKS   ON  PNEUMOTHORAX.  213 

water  let  fall  into  a  flask  three  quarters  empty, 
and  this  sound  is  immediately  followed  by  a  dis- 
tinct metallic  tinkling.  A  similar  sound,  he  says, 
may  be  heard  by  ausculting  the  epigastrium  of  a 
person  who  is  swallowing  water  in  minute  quan- 
tities. This  explanation  has  been  adopted,  by 
various  subsequent  writers,  as  a  general  mode 
of  accounting  for  the  phenomenon  of  metallic 
tinkling. 

Dr.  C.  J.  B.  Williams,  author  of  valuable  works 
on  diseases  of  the  lungs  and  pleura,  explains 
metallic  tinkling  on  the  principle  of  reverbera- 
tion, or  echo,  produced  in  a  cavity  of  uniformly 
reflecting  parietes  by  the  communication  of  a 
sound,  or  of  a  soniferous  impulse,  to  the  air  con- 
tained within  it.  He  considers  that  in  common 
cases  of  pneumothorax  communicating  with  a 
bronchus,  if  the  fistulous  opening  be  small,  metal- 
lic tinkling  will  be  produced,  but  if  large,  or  if 
several  such  openings  exist,  there  will  be  only 
amphoric  resonance. 

Dr.  Thomas  Davies,  in  his  lectures  at  the  Lon- 
don Hospital  on  diseases  of  the  chest,  says : 
"  The  metallic  tinkling  is  caused  by  the  resonance 
of  air  agitated  upon  the  surface  of  a  liquid  con- 


214  REMARKS   ON   PNEUMOTHORAX. 

tained  in  a  preternatural  cavity  formed  in  the 
chest."  *  This  explanation  may  have  been  sug- 
gested by  a  note  of  M.  Meriadec  Laennec  in  his 
edition  of  the  great  work  of  his  relative,  who 
says  that  the  sound  in  question  appears  to  depend 
upon  the  vibration  of  a  gas  upon  the  surface  of  a 
liquid. 

Dr.  James  Houghton,  author  of  the  article 
Pneumothorax  in  the  Cyclopedia  of  Practical 
Medicine,  adopts  the  idea  of  an  echo,  which  he 
derives  both  from  the  dropping  of  fluid  in  a 
cavity,  and  from  the  entrance  of  air  through  a 
fistulous  opening.  The  latter  variety,  he  says, 
appears  to  be  manifestly  the  echo  of  the  air 
forced  into  the  cavity,  reverberating  against  its 
hollow  parietes;  and  the  sound,  he  thinks,  is 
more  particularly  caused  by  the  bursting  of 
minute  air-bubbles  at  the  orifice  of  the  fistula, 
formed  as  the  air  traverses  the  latter  by  the 
entanglement  of  mucus.  He  thinks  that  the 
tinkling  will  be  more  or  less  loud  and  distinct  in 
proportion  as  the  fistulous  opening  is  larger  or 
smaller. 

Mr.  Guthrie,  in  the  London  Medical  and  Surgi 

*  London  Medical  Gazette,  vol.  rv. 


REMARKS   ON   PNEUHOTHORAX.  215 

cal  Journal,  1833,  asserts  that  Laennec,  and  also 
all  who  hold  that  metallic  tinkling  "  depends 
entirely  on  the  passage  of  air  through  a  hole  in 
the  lung  into  the  cavity  of  the  thorax,"  have 
been  mistaken ;  and  in  opposition  to  this  he 
mentions  that  to  produce  the  sound  in  question 
the  air  in  the  cavity  must  necessarily  be  com- 
pressed. "  I  do  not,"  says  he,  "  deny  the  facts  of 
the  air,  the  hole  in  the  lung,  or  the  fluid  ;  but  I 
believe  that  to  produce  the  sounds  of  the  Jews' 
harp  (metallic  tinkling)  the  air  in  the  cavity  must 
be  greatly  compressed." 

M.  Beau,  a  French  writer  on  the  causes  of  the 
respiratory  bruits,  is  not  satisfied  with  the  ex- 
planation of  Laennec,  and  contends  that  metallic 
tinkling  is  produced  by  a  bubble  of  air,  which, 
having  traversed  the  fluid,  bursts  upon  its  sur- 
face. He  founds  his  opinion  on  the  fact  that  he 
has  never  witnessed  metallic  tinkling  when  the 
communication  with  the  external  air  was  above 
the  level  of  the  fluid.  Dr.  Spittal,  of  Edinburgh, 
seems  to  have  suggested  this  explanation  of 
metallic  tinkling,  by  the  bursting  of  air-bubbles, 
as  early  as  1830. 

Magendie,  in  his  lectures  quoted  in  the  Lancet 


216  REMARKS    ON   PNEUMOTHORAX. 

of  1835,  says:  "The  causes  which  produce  the 
tintement  metallique  are  not  by  any  means  well 
understood.  Suppositions  have  been  made  (they 
are  made  and  abandoned  with  surprising  facility 
in  medicine),  but  when  we  come  to  examine 
them,  we  find  nothing  but  mere  theories  without 
any  shadow  of  proof."  He  tells  us  that  the  sup- 
position that  a  drop  of  liquid  sticks  to  the  upper 
part  of  a  cavity,  and  then  falls  into  the  fluid 
below,  is  mere  hypothesis,  which  may  or  may 
not  be  true.  He  also  denies  the  sufficiency  of 
the  explanation  that  the  tinkling  is  caused  by  a 
bubble  which  traverses  a  fluid,  and  bursts  upon 
its  surface.  His  objections  are  grounded  on  an 
experiment,  which  he  proceeds  to  repeat  in 
presence  of  his  class,  showing  the  insufficiency 
of  both  these  causes  to  produce  metallic  tink- 
ling. In  a  dead  subject,  a  quantity  of  fluid 
amounting  to  about  half  a  pint  was  thrown  into 
the  chest.  A  perforation  was  then  made  through 
the  pulmonary  tissue,  so  as  to  establish  a  com- 
munication between  the  bronchi  and  cavity  of 
the  chest.  A  quantity  of  air  was  then  forced 
in  through  the  trachea,  so  as  to  enter  the  pleura! 
cavity.  No  metallic  sound  was  produced  in  the 


REMAKES    ON  PKEUMOTHOBAX.  217 

operation.  Water  was  then  dropped  in  through 
an  opening  in  the  upper  part  of  the  chest  upon 
the  fluid  below,  but  this  also  produced  no  tink- 
ling. Another  orifice  was  made  in  the  lung 
beneath  the  surface  of  the  fluid,  and  air  injected 
as  before.  A  bubbling  sound,  or  "  craquement," 
was  heard  in  the  chest,  but  nothing  of  a  metallic 
or  tinkling  character  could  be  perceived.  Ma- 
gendie  considers  himself  as  having  disproved  the 
explanations  to  which  his  experiments  relate, 
but  he  does  not  offer  any  new  one  of  his  own. 

In  regard  to  M.  Guthrie's  explanation,  which 
supposes  the  necessity  of  compressed  air  being 
present,  this  has  been  effectually  set  aside  by 
the  fact,  that,  although  in  extreme  pneumotho- 
rax  the  air  in  the  pleura  is  moderately  com- 
pressed, yet  metallic  tinkling  is  known  to  be  also 
produced  in  large  tubercular  cavities  of  the 
lungs,  which  communicate  freely  with  the  atmos- 
phere, and  therefore  are  not  subject  to  any  com- 
pression whatever. 

The  solution  of  this  phenomenon,  given  by  Dr. 
Davies,  and  Laennec  Junior,  that  it  is  caused  by 
the  resonance  of  air,  agitated  upon  the  surface 
19 


218  REMARKS    ON   PXEUMOTHORAX. 

of  a  liquid,  seems  to  be  too  vague  and  unsup- 
ported to  require  particular  attention. 

In  regard  to  the  explanations  given  by  Drs. 
Williams  and  Houghton,  which  ascribe  metallic 
tinkling  to  an  echo,  or  reverberation  of  air  from 
the  sides  of  a  cavity,  the  solution  seems  to  me 
to  be  neither  adequate  nor  very  probable.  Echo 
is  the  secondary  sound  produced  by  the  reflected 
vibrations  of  the  atmosphere.  It  becomes  power- 
ful only  when  many  reflections  converge  towards 
the  same  point.  Air,  moreover,  is  a  feeble  con- 
ductor of  sound,  when  compared  with  liquid  or 
solid  bodies.  It  is  unnecessary,  therefore,  to 
suppose  that  one  of  the  most  striking  sounds 
heard  in  auscultation  is  produced  by  the  second- 
ary movement  of  a  feeble  conductor,  when  we 
have  between  the  ear  and  the  place  of  impulse 
the  direct  agency  of  a  much  more  powerful  con- 
ductor, namely,  a  liquid.  To  elucidate  this 
point,  let  any  one  perform  the  following  experi- 
ment :  Into  a  large  earthen  or  porcelain  bowl, 
pour  a  few  ounces  of  water.  Then  produce  a 
slight  and  barely  audible  sound,  by  rubbing  or 
snapping  together  the  ends  of  the  nails  of  the 
thumb  and  finger.  If  this  sound  is  made  in  the 


REMARKS    ON   PNEUMOTHORAX.  219 

air  in  any  part  of  the  cavity  of  the  bowl  above 
the  water,  it  remains  feeble,  but  if  the  nails  be 
immersed  below  the  surface  of  the  water,  the 
sound  instantly  becomes  augmented  to  many 
times  its  former  intensity,  and  it  will  be  par- 
ticularly intense  to  the  ear  of  an  ausculter  ap- 
plied to  the  outside  of  the  bowl.  Here,  then,  is 
a  parallel  case.  The  liquid  in  Pneumothorax,  and 
not  the  air,  as  will  hereafter  be  seen,  conveys  the 
sound  of  metallic  tinkling  to  the  walls  of  the 
chest,  and  these  transmit  it  to  the  ear  of  the 
ausculter,  constituting  an  uninterrupted  chain  of 
vibrations. 

Considering  the  subject  as  being  yet  imper- 
fectly explained,  and  therefore  open  to  further 
inquiry,  I  have  made  some  experiments  in  con- 
nection with  the  following  cases,  which  I  hope 
will  not  be  found  irrelevant  to  the  question. 

CASE  I.  —  J.  B.,  cordwainer,  aged  forty-four, 
entered  the  Massachusetts  General  Hospital,  De- 
cember 28th,  1836.  He  had  been  troubled  with 
cough  and  dyspnoea,  during  most  of  last  year, 
increased  during  summer.  Yesterday,  after  ex- 
posure to  cold  during  perspiration,  had  a  sudden 


220  CASES   OF   PNEUMOTHOEAX. 

increase  of  cough  and  dyspnoea  with  pain  shoot- 
ing from  side  to  side,  and  hoarseness.  Now,  skin 
hot  and  dry,  face  flushed,  pulse  98,  respiration 
short,  quick,  50  per  minute,  cough  hard,  with 
viscid  frothy  mucous  sputa.  Complains  of  pain 
in  head  and  across  hypochondria,  increased  by 
upward  pressure  or  cough,  tongue  white,  costive- 
ness,  dysury  with  frequent  micturition. 

29th,  31st.  Percussion  dull  on  right  back,  suf- 
ficiently resonant  on  left.  Respiration  very  fee- 
ble in  right  back,  with  a  slight  bronchial  sound 
opposite  spine  of  right  scapula.  Bronchophony 
well  pronounced  in  same  place.  Supplementary 
puerile  respiration  in  left  back.  Hoarseness 
amounting  to  aphonia,  cough  frequent,  painful, 
with  dyspnoea.  About  §ii.  of  muco-purulent 
sputa  daily.  Costive  ;  sleeps  little. 

January  2d,  1837.  Has  rested  and  felt  some- 
what better  for  two  days.  In  right  back  respira- 
tion nearly  inaudible,  but  voice  and  cough  dis- 
tinctly amphoric. 

4th.  By  degrees  the  respiration  in  right  back 
has  grown  more  audible  and  amphoric.  Percus- 
sion resonant.  In  left  back  voice  natural,  respi- 


CASES   OF  PNEUMOTHORAX.  221 

ration  puerile.  Purulent  sputa,  one  to  three 
ounces. 

5th,  8th.  Metallic  tinkling  in  right  back,  at 
lower  edge  of  scapula,  slight  and  few,  heard  on 
each  day.  Amphoric  respiration;  voice  and  cough 
audible  from  summit  to  base  of  right  chest.  Dysp- 
noea and  cough  more  easy.  Percussion  of  right 
back  tympanitic  to  base  of  chest;  right  back 
when  viewed  vertically  much  more  prominent  to 
the  eye  than  left ;  semi-circumference  an  inch 
greater ;  intercostal  spaces  prominent,  the  ante- 
rior ones  level  in  supine  posture.  In  erect  pos- 
ture, base  of  right  chest  less  resonant  than  when 
lying  on  face  or  left  side. 

9th.  Paroxysms  of  great  dyspnoea,  obliging 
him  to  get  out  of  bed.  Breath,  voice  and  cough 
amphoric  from  summit  to  base  of  right  back. 
Frequent  metallic  tinkling.  Resonance  of  front 
and  back,  of  right  side  on  percussion.  Purulent 
sputa,  giss. 

llth.  Rested  better;  pulse  104;  anterior  right 
chest  tympanitic  on  percussion,  with  inaudible 
respiration  from  top  to  base ;  voice  scarcely 
audible  through  parietes  at  same  place,  but  tow- 
ards base  amphoric.  Respiration  in  right  back 
19* 


222  CASES   OF  PNEUMOTHORAX. 

feeble,  but  amphoric,  accompanied  by  continual 
metallic  tinkling,  frequent  and  rapid,  resembling 
the  boiling  of  a  fluid  in  a  glass  retort  or  flask. 
Respiration  highly  puerile  in  whole  left  back ; 
slight  gurgling  under  clavicle.  Very  great  ex- 
haustion and  anhelation,  after  rising  to  cough. 
Generally  unable  to  expectorate  unless  he  turns 
upon  his  left  side,  after  which  movement  the  pus 
flows  freely. 

12th,  13th.  Many  turns  of  violent  and  suffo- 
cative  dyspnoea ;  metallic  tinkling  softer.  Res- 
piration in  right  back  very  feeble,  in  left  back 
puerile. 

14th,  16th.  Breathes  with  more  ease.  Some 
ounces  of  purulent  sputa  raised  each  day.  Am- 
phoric or  metallic  respiration,  voice  and  cough, 
with  metallic  tinkling  more  rare  and  feeble. 
Right  anterior  chest  quite  resonant  on  percus- 
sion, to  the  extreme  base  of  the  chest  on  in- 
spiration, but  about  an  inch  less  in  extent  at 
expiration. 

From  this  time  he  continued  delirious,  with 
occasional  twitching  of  muscles ;  respiration  high 
and  rapid  ;  inaudible,  or  amphoric,  in  right  front ; 


CASES   OF  PNEUMOTHOEAX.  223 

faint  metallic  impulses  and  mucous  rales  till  the 
21st,  when  he  died. 

Autopsy  f  two  and  a  half  hours  post  mortem.  — 
Emaciation  not  great ;  right  side  of  thorax  en- 
larged ;  intercostal  spaces  obliterated,  this  side 
measuring  an  inch  more  than  the  left,  opposite 
the  lower  end  of  the  sternum.  Percussion  reso- 
nant, for  a  quarter  of  the  semi-circumference,  flat 
behind.  Succussion  of  the  chest  gives  a  distinct 
metallic  sound  from  the  motion  of  fluid.  The 
right  chest,  when  perforated  through  water  (see 
Experiment  I.),  discharged  much  air,  and  sub- 
sided gradually. 

Thorax.  Right  pleura  with  strong  old  adhe- 
sions at  apex,  and  along  mediastinum ;  elsewhere 
covered  with  false  membranes,  mostly  free,  soft, 
whitish,  recent.  Its  cavity  contains  nearly  two 
quarts  of  opaque  sero-purulent  fluid,  with  de- 
tached flocculerit  masses  of  lymph.  The  lung 
being  inflated  in  situ,  air  issued  freely  from  be- 
hind the  base  near  the  spine,  but  the  orifice 
could  not  subsequently  be  identified,  on  account 
of 'the  rupture  of  cavities  made  in  removing  the 
adherent  lung  from  the  chest.  Right  lung  greatly 
compressed,  condensed,  and  nearly  devoid  of  air, 


224  CASES   OF   PNEUMOTHORAX. 

the  upper  lobe  half  destroyed  by  an  abscess,  a 
cavity  an  inch  square  in  the  upper  part  of  the 
lower  lobe,  and  tubercles  scattered  through  all. 
Left  pleura  with  some  old  adhesions.  Lung 
large,  somewhat  emphysematous,  upper  and  low- 
er lobes  tuberculous,  a  cavity  capable  of  holding 
§i.  in  the  upper  part  of  the  lower  lobe.  Air-pas- 
sages of  natural  size,  some  redness  in  right  bron- 
chi. Glands  at  bifurcation  of  trachea  healthy ; 
those  in  upper  part  of  thorax  and  the  cervical, 
enlarged  and  moist,  but  not  tuberculous. 

Pericardium  contained  about  an  ounce  of  tur- 
bid serum,  with  flocculi  of  recent  lymph ;  heart 
healthy ;  right  auricle  slightly  adherent ;  blood 
in  right  side  partly  liquid,  partly  coagulated, 
with  some  fibrin  j  in  left  auricle  the  same,  but 
no  separate  fibrin. 

Abdomen.  Liver  of  average  size,  rather  dark 
and  friable,  pushed  down  so  as  to  reach  the 
umbilicus,  compressed  so  that  its  superior  and 
anterior  surfaces  formed  a  right  angle.  Gall- 
bladder containing  §v.  of  very  dark  viscid  bile. 
Stomach  sufficiently  healthy,  except  some  small 
red  spots  about  the  small  curvature.  Mucous 
membrane  of  small  intestines  healthy. 


CASES   OF   PNEUMOTHOKAX.  225 

CASE  II.  —  I.  C.,  aged  forty-four,  sailor,  entered 
the  hospital  May  28th.*  He  was  previously  in 
the  house,  three  months  ago,  with  cough,  and 
slight  tuberculous  signs.  He  now  reports  that 
he  kept  at  work,  continuing  pretty  well,  until  May 
24th,  when  he  had  headache  and  dizziness  in  the 
afternoon,  referred  to  having  got  wet  in  the  rain 
the  night  before  ;  in  the  evening  fainted,  and  in 
the  night  had  coughing  and  retching ;  raised 
without  pain  §ss.  more  or  less  of  frothy  blood ; 
has  had  much  cough  since,  mostly  in  the  night, 
with  scanty  expectoration  of  frothy  rnucus ; 
cough  and  long  inspiration  have  caused  pain  in 
the  right  side,  and  across  the  chest ;  has  had  no 
other  pain,  no  chills  nor  flushes ;  but  has  per- 
spired considerably  ;  has  had  little  appetite  and 
much  thirst,  bowels  have  been  open  daily  ;  urine 
high-colored  ;  feels  very  weak  ;  tongue  clean  for 
most  part,  a  little  coated  at  roots  ;  pulse  118. 

29th.  Slept  better  than  out  of  house,  but 
coughed  considerably  towards  morning. 

30th.  Rested  badly  from  great  dyspnoea,  which 
came  on  between  nine  and  ten  last  night ;  bathed 

*  This  case  was  most  of  the  time  under  the  care  of  Dr.  Hale. 


226  CASES   OP  PNEUHOTHOKAX. 

in  a  sweat ;  pulse  96  ;  mucous  rale  in  the  throat; 
amphoric  sound  in  respiration  below  left  scapula; 
percussion  resonant  in  the  same  place  ;  respira- 
tion puerile  on  the  other  side ;  lies  on  the  right ; 
much  distressed  by  lying  on  the  back  or  left  side. 
Half  a  pint  of  thin  mucous  fluid  sputa,  frothy  on 
top  and  opaque. 

31st.  Rested  badly  from  dyspnoea  requiring 
him  to  maintain  a  stooping  posture  ;  five  or  six 
dejections  ;  pulse  132  sitting  up  ;  dyspnoea  now 
less  urgent ;  a  highly  distinct  metallic  tinkle 
heard  in  the  left  chest,  disappearing  when  he 
stoops  forward,  returning  as  he  bends  back. 
Just  below  the  angle  of  the  left  scapula  strong 
amphoric  respiration  with  clear  metallic  tinkle. 
In  axillary  region  sound  as  of  striking  a  brass 
vessel  with  a  nail ;  great  resonance  of  the  left 
chest,  both  behind  and  in  front,  on  percussion. 
Strongly  puerile  respiration  in  the  right  back. 

June  1st.  Slept  half  the  night,  by  intervals, 
sitting  up  and  stooping  forward.  No  dejection  ; 
pulse  144 ;  tongue  moist,  thick  coat  on  centre, 
livid ;  countenance  distressed,  anxious ;  respira- 
tion 32,  laborious  ;  no  pain  when  at  rest,  but  on 
motion  sharp  pain  through  the  left  chest,  below 


CASES   OP  PNEUMOTHORAX.  227 

the  region  of  the  heart ;  speaks  only  in  a  whis- 
per ;  feet  and  ankles  cedematous ;  whole  left 
chest,  both  front  and  back,  very  resonant ;  res- 
piration amphoric,  with  metallic  tinkling  loud 
and  musical  in  the  whole  left  back  below  spine 
of  scapula,  and  whole  left  front  from  clavicle 
downwards. 

2d.  Slept  pretty  well  in  the  same  posture  as 
last  night;  two  dejections;  countenance  anxious; 
skin  warm,  with  profuse  perspiration ;  pulse  144 ; 
tongue  white  in  centre,  livid,  moist ;  respiration 
30,  laborious  ;  voice  better  than  yesterday  ;  am- 
phoric resonance  diminished ;  metallic  tinkling 
as  yesterday. 

3d.  Slept  pretty  well  in  his  chair,  as  before  ; 
pulse  128  ;  respiratipn  32,  somewhat  less  labori- 
ous, except  after  coughing  ;  unable  to  lie  down  ; 
cough  not  frequent,  but  paroxysms  long  and  se- 
vere ;  percussion  everywhere  very  resonant  in 
left  chest  except  for  a  small  space  about  spine  of 
scapula,  where  it  is  only  equal  with  the  right ; 
resonance  continues  to  the  very  base  of  chest ; 
respiration  vesicular,  but  feeble  about  spine  of 
scapula  ;  amphoric  in  lower  half  of  back ;  natural 
respiration  without  metallic  tinkle  ;  after  cough- 


228  CASES   OF   PNEUMOTHORAX. 

ing  large  and  musical  tinkle  ;  in  front  no  respira- 
tion heard  below  line  one  inch  below  nipple ; 
above  that  metallic  tinkle  for  the  space  of  two 
or  three  inches,  and  above  amphoric  resonance 
in  natural  respiration ;  in  forced  respiration  me- 
tallic tinkle  over  whole  left  chest ;  no  resonance 
of  voice  ;  in  right  chest  respiration  puerile. 

4th.  Slept  pretty  well  in  posture  as  for  the 
last  four  nights ;  countenance  less  distressed ; 
pulse  124 ;  cough  less  difficult,  but  still  laborious; 
about  §iss.  of  adhesive  muco-purulent  sputa:  skin 
moist  and  warm ;  resonance  of  left  back  less  than 
for  some  days  past,  though  still  greater  than  nat- 
ural except  about  scapulas ;  immediately  over 
and  above  scapulas,  percussion  nearly  or  quite 
equal  in  both  backs ;  on  two  lower  ribs  of  left 
back  percussion  resonant  while  leaning  forward, 
flat  on  leaning  backwards ;  respiration  in  left 
back  vesicular  about  scapulas  and  for  an  inch  or 
two  below,  then  amphoric  for  a  space  about  the 
breadth  of  the  hand,  inaudible  at  base  ;  no  reso- 
nance or  tremor  of  voice  discovered  either  in 
back  or  side ;  metallic  tinkling  in  front  as  before  ; 
also  in  back  after  cough.  Sudamina  above  and 
about  clavicles. 


CASES   OF   PNEUMOTHOKAX.  229 

5th.  In  bed  most  of  the  night,  lying  on  right 
side;  slept  two  or  three  hours;  four  or  five  dejec- 
tions ;  countenance  improved ;  §ii.  of  adhesive 
muco-purulent  sputa  ;  pulse  108  ;  tongue  clear  at 
edges,  moist,  coated  in  centre  ;  percussion  reso- 
nant down  to  sixth  rib  in  left  chest ;  flat  imme- 
diately below  ;  equal  in  both  backs  over  scapulae, 
and  for  two  fingers'  breadth  below ;  below  that 
much  more  resonant  on  left  side,  down  to  last 
rib,  while  leaning  forward.  When  leaning  back, 
more  dull  in  the  whole  of  the  resonant  space  in 
back.  Natural  respiration  vesicular  about  scap- 
ulas, with  sonorous  rale ;  below  scapulas,  ampho- 
ric resonance.  In  front,  metallic  tinkle  after 
cough ;  metallic  tinkle  also  in  back.  No  reso- 
nance of  voice  at  base  of  chest. 

7th.  In  chair  all  night ;  slept  three  hours  at 
intervals  ;  five  dejections  ;  countenance  more  dis- 
tressed ;  pulse  132 ;  respiration  36,  more  labored 
than  for  the  last  two  or  three  days.  Tongue 
cleaner,  rather  less  livid;  nearly  §ii.  adhesive 
sputa ;  coughs,  he  thinks,  about  once  an  hour ; 
percussion  dull  in  back  on  lower  rib,  when  lean- 
ing forward ;  respiration  amphoric  both  in  front 
20 


230  CASES   OP   PNEUMOTHORAX. 

and  back ;  natural  .breathing  unaccompanied  by 
tinkle. 

8th.  Kept  awake  by  difficulty  of  breathing. 
Cough  less ;  expectoration  about  §i.  adhesive 
purulent  mucus.  Countenance  much  distressed, 
pulse  132 ;  tongue  more  coated ;  respiration  32, 
labored.  Hair,  skin  and  clothing  wet  with  per- 
spiration. In  natural  respiration  very  little  sound 
perceived,  except  some  amphoric  resonance  and 
occasional  metallic  tinkling.  Percussion,  when 
leaning  much  forward,  flat  on  lower  rib,  resonant 
above ;  when  sitting  up,  flat  on  four  lower  ribs. 
A  peculiar  metallic  ringing  sound  perceived  by 
ear  applied  to  sternum,  when  the  back  is  per- 
cussed. 

llth.  In  the  chair  all  night;  slept  none  from 
dyspnoea;  some  pain  in  left  chest;  two  dejec- 
tions; countenance  much  distressed;  coughs 
little ;  expectoration  pretty  easy ;  §ii.  of  adhesive 
muco-purulent  sputa;  pulse  144;  percussion  flat 
below  nipple,  also  in  back  below  corresponding 
line,  resonant  above ;  sonorous  rale  in  whole 
front  chest.  No  other  sound  in  natural  breath- 
ing. Amphoric  resonance  in  back,  feeble  in 


CASES   OF   PNEUMOTHORAX.  231 

natural  breathing,  loud  and  musical  after  cough. 
After  speaking,  metallic  tinkling  in  front. 

12th.  Lay  on  couch  all  night  without  having 
head  much  raised.  Could  lie  on  left  side  as  well 
as  right,  the  first  time  for  several  weeks.  Rested 
very  well,  but  did  not  sleep  much;  one  dejec- 
tion ;  respiration  367  somewhat  labored,  but  less 
so  than  for  several  days  past.  Countenance  less 
distressed  ;  pulse,  after  waking,  108 ;  tongue 
much  less  livid,  moist,  with  a  broken  coat  in 
centre.  Percussion  of  left  chest  (still  lying  on 
left  side)  quite  resonant,  except  at  most  depend- 
ent part  of  side,  where  it  is  flat.  In  natural 
respiration,  the  only  sound  heard  is  sibilant  rale 
both  in  front  and  back.  Forced  respiration, 
either  in  speaking  or  other  effort,  amphoric. 
Coughed  but  little  ;  less  than  §i.  adhesive,  white, 
frothy,  mucous  sputa.  Immediately  after  rising, 
loud,  ringing,  amphoric  resonance  in  respiration, 
and  especially  in  cough,  heard  both  in  back  and 
front.  Limit  of  flat  sound  on  sitting,  on  a  line  an 
inch  below  the  nipple.  Same  metallic  ringing 
sound  on  percussion  of  chest  as  before. 

13th.  In  erect  posture  most  of  night ;  slept 
little  from  dyspnoea ;  three  dejections.  Discharge 


232  CASES   OF   PNEUMOTHORAX. 

from  bowels  thin  and  watery  ;  countenance  mod- 
erately distressed  ;  perspiration  not  excessive ; 
pulse  116,  tolerably  full ;  respiration  36,  high, 
laborious.  In  erect  position,  resonance  on  per- 
cussion extends  down  to  one  finger's  breadth 
below  nipple.  Below  this  line,  intercostal  spaces 
on  a  level  with  ribs ;  above,  intercostal  spaces 
projecting,  resonant.  In  ordinary  respiration, 
amphoric  resonance  loud  and  distinct  in  upper 
part  of  chest.  A  ringing  sound,  on  percussion, 
as  before.  No  metallic  tinkling  heard.  Abdo- 
men full,  moderately  resonant. 

14th.  Slept  very  well,  lying  down,  on  either 
side;  four  dejections.  Countenance  less  dis- 
tressed; feels  better;  pulse  108;  respiration  36, 
moderately  labored.  Inspiration  and  expiration 
nearly  equal.  Percussion  flat  below  line,  a 
finger's  breadth  below  nipple,  resonant  above. 
Same  ringing  sound  as  before,  on  percussion. 
Sounds  of  fluid  readily  distinguishable  on  suc- 
cussion,  heard  with  ear  at  a  distance  of  a  foot 
from  chest.  Moderate  amphoric  resonance  in 
ordinary  respiration.  Two  sides  of  chest  nearly 
equal  on  measurement ;  left  mamma  more  promi- 
nent to  the  eye  than  right,  intercostal  spaces 


CASES   OP   PNEUMOTHOKAX.  233 

protruding  slightly.  After  some  fatigue,  ampho- 
ric resonance,  ringing.  Eibs  of  left  chest  scarcely 
raised  in  respiration. 

15th.  Slept  pretty  well,  mostly  in  sitting  pos- 
ture ;  three  dejections.  Breathing  more  difficult 
when  he  attempted  to  lie  down.  Countenance 
anxious  and  distressed;  skin  quite  cool,  wet  with 
perspiration ;  large  sudamina  about  clavicles ; 
respiration  36,  laborious.  Inspiration  quicker 
than  expiration.  Cough  little.  Percussion  about 
spines  of  scapulae  still  equal  on  both  sides.  Or- 
dinary respiration  amphoric  and  ringing ;  when  a 
little  forced,  voice  and  percussion  ringing  as 
before.  Sound  of  fluid  on  succussion  heard  at 
a  distance  of  several  feet. 

17th.  Slept  most  of  night  in  sitting  posture 
and  recumbent,  lying  on  back  or  right  side. 
Countenance  much  distressed;  respiration  quite 
laborious  ;  inspirations  quick ;  pulse  112.  Tongue 
moist,  slight  coat  on  lobes,  very  slightly  livid ; 
skin  cool  and  moist.  Pain  near  left  nipple  if  he 
lies  On  left  side ;  no  pain  when  at  rest  in  any 
other  position.  Very  little  cough,  §ii.  frothy 
mucous  sputa.  Line  of  flat  sound  level  with 
nipple;  respiration  in  right  chest  loud  and 
20* 


234  CASES   OF   PJtEUMOTHORAX. 

coarse.  Sounds  in  left  chest  as  before.  Ring- 
ing sound  on  percussion  perceptible  when  per- 
cussion is  on  same  surface  with  ear,  in  erect 
position. 

18th.  At  six  and  a  half  A.  M.  found  lying 
on  back  with  shoulders  raised,  breathing  quick 
and  with  tracheal  rale.  Eyes  closed ;  pulse  very 
small  and  feeble;  extremities  cold.  Died  soon 
after. 

Autopsy,  eight  hours  post  mortem.  —  Body  not 
much  emaciated,  skin  livid,  lower  extremities 
oedematous. 

Left  chest  quite  resonant  to  a  line  with  axilla, 
flat  behind  this  line.  Right  side  dull  over  whole 
space  below  pectoral  muscles.  The  air  rushed 
out  from  a  perforation  on  left  side,  as  detailed  in 
Experiment  I.  Left  pleura  universally  inflamed, 
mostly  red  and  roughened,  and  lined  with  a  soft, 
bluish-white  false  membrane  of  variable  thick- 
ness, separable  in  some  places  into  layers,  con- 
taining about  five  pints  of  thin,  purulent,  inodor- 
ous liquid,  with  coarse  masses  of  lymph  lying 
loose  in  the  depending  parts.  Left  lung  col- 
lapsed very  small,  fleshy,  bluish-black,  pressed 
against  spine  and  ribs,  and  nearly  destitute  of 


CASES   OF   PNEUMOTHORAX.  235 

air,  having  a  coat  of  lymph,  and  adhering  behind 
superiorly.  A  rounded  fistulous  opening  was 
found,  half  a  line  in  diameter,  and  situated  on  the 
posterior  surface  of  the  lower  lobe,  an  inch  and 
a  half  below  its  summit.  Through  this  orifice 
air  issued,  if  blown  into  the  trachea,  and  a  probe 
pressed  upwards  entered  a  large  bronchus.  This 
opening  communicated  immediately  with  a  super- 
ficial cavity  an  inch  long  by  half  an  inch  broad, 
and  which  contained  a  whitish,  friable,  opaque 
substance.  No  other  cavity  was  found,  but 
small  tubercles  and  gray  granulations  in  various 
parts  of  this  lung.  The  bronchi  contained  bloody 
fluid,  were  pale,  thin  and  polished,  excepting  that 
which  led  to  the  cavity,  and  which  was  thickened, 
darker,  and  less  polished. 

Right  lung  universally  adherent  by  pale,  soft, 
friable,  recent  membrane,  forming  bands  below, 
some  of  them  an  inch  long,  among  which  were 
cavities,  containing  §viii.  of  reddish  fluid.  This 
lung  contained  many  tubercles,  and  a  cavity  an 
inch  long  at  its  apex. 

In  front  of  the  neck  was  a  tumor,  occasioned 
by  an  abscess  situated  between  sterno-hyoid  mus- 


236  CASES   OF  PNEUMOTHOKAX. 

cles,  containing  §ss.  of  pus,  with  a  lining  of 
tuberculous-looking  matter. 

Pericardium  pushed  to  the  right  side  more  than 
two  thirds  of  it  beyond  the  median  line.  Heart 
healthy,  except  perhaps  slight  hypertrophy  of 
left  ventricle,  which  measured  five-eighths  of  an 
inch  thick  at  base,  and  five-sixteenths  at  apex. 
Weight,  nine  and  a  half  ounces. 

Liver  somewhat  enlarged,  rather  dark,  pushed 
down  within  an  inch  or  two  of  the  umbilicus. 
Small  intestines  tuberculous,  especially  on  Pey- 
er's  plates,  towards  the  end  of  the  ilium,  but  no 
ulcers.  Other  viscera  mostly  natural. 

CASE  III.  —  A.  C.,  a  young  gentleman,  aged 
twenty,  called  me  to  visit  him  June  28th,  having 
just  returned  from  a  journey  to  the  South.  He 
reported  that  two  years  previously  he  had  had 
a  "  lung  fever,"  since  which  time  his  health  has 
not  been  good.  Last  summer  he  was  troubled 
with  slight  pains  in  the  chest,  emaciation,  loss 
of  strength,  and  some  hectic  symptoms,  but  does 
not  recollect  much  cough.  Being  considered 
phthisical  by  his  physician,  he  had  been  advised 
to  pass  the  winter  in  the  Southern  States.  My 


CASES   OF   PNEUMOTHORAX.  237 

first  visit  was  made  to  him  on  the  second  day 
after  his  return,  and  one  day  before  his  death. 
I  found  him  thin  and  feeble,  barely  able  to  sit  up, 
with  a  hot  skin  and  circumscribed  redness  on  his 
-cheek.  Dyspnoea  by  no  means  urgent,  decubi- 
ture  dorsal,  pain  and  stricture  across  both 
hypochondria,  and  none  felt  elsewhere ;  pulse 
80.  Left  chest  tympanitic,  respiration  inaudi- 
ble ;  a  slight  metallic  tinkle  heard  singly  at  each 
inspiration  and  expiration.  Pulsations  of  heart 
feeble  in  cardiac  region,  stronger  on  right 
side.  On  the  following  day,  without  any  great 
aggravation  of  dyspnoea  or  distress,  he  became 
much  prostrated,  with  a  small,  irregular  pulse, 
cold  sweats,  and  diminished  sensibility,  and 
died  on  the  succeeding  night.  By  his  own 
testimony  and  that  of  his  friends,  his  cough 
had  been  slight,  and  the  dyspnoea  at  no  time 
urgent. 

Autopsy,  sixteen  hours  after  death. — The  whole 
anterior  chest  resonant,  the  left  tympanitic. 
On  perforating  the  left  chest  through  water, 
great  quantities  of  air  escaped.  [See  Experi- 
ment I.]  The  quantity  of  sero-purulent  fluid 
was  not  estimated,  water  having  been  thrown 


238  CASES   OP  PNEUMOTHORAX. 

into  the  chest  for  the  Bake  of  the  experiment. 
The  left  lung  was  adherent  superiorly  and 
posteriorly,  and  had  tubercles  and  cavities  in 
its  upper  lobe.  The  lower  part  of  the  same 
lobe  was  indurated  by  tuberculous  infiltration, 
and  had  about  the  color  of  gray  hepatization. 
No  communication  between  the  bronchise  and 
chest  was  detected  except  those  produced  in 
the  cavities  torn  in  the  separation.  Right  lung 
healthy,  excepting  a  few  tuberculous  lumps 
in  its  upper  lobe.  The  heart  was  very  small 
and  flaccid,  and  was  pushed  almost  wholly  into 
the  right  chest.  Mitral  valves  somewhat  thick- 
ened at  their  roots  with  slight  vegetation. 
Liver  depressed,  dark  purple,  flaccid.  Gall- 
bladder healthy. 

I  consider  the  last  case  as  noticeable  for  the 
absence  of  any  great  dyspnoea  or  distress,  after 
the  signs  of  pneumothorax  were  so  distinct  as  to 
lead  to  an  unequivocal  diagnosis  of  that  disease. 
I  have  seen  similar  cases  where  the  pneumotho- 
rax was  partial,  owing  to  the  adhesions  of  the 
lung  preventing  collapse,  a  case  not  wholly 
uncommon. 


EXPERIMENTS.  239 

EXPERIMENT  I. 

Previously  to  the  autopsies  of  the  patients 
who  were  the  subjects  of  Cases  I.  and  II.,  a 
glass  cylinder,  open  at  both  ends,  was  pressed 
into  close  contact  with  the  chest,  so  as  to 
hold  water.  Some  ounces  of  that  fluid  were 
poured  in,  and  a  perforation  was  made  through 
it  into  the  cavity  of  the  chest  on  the  dis- 
tended side.  Immediately  a  large  volume  of 
air  escaped  from  the  chest,  bubbling  upwards 
through  the  water.  In  the  third  case,  no  cylin- 
der being  at  hand,  a  superficial  cavity  was  made 
out  of  the  dissected  integuments  of  the  chest, 
and  filled  with  water.  Through  this  water  a 
perforation  of  the  chest  was  made  on  the  left 
anterior  surface.  The  air  rushed  out,  producing 
strong  ebullition,  as  in  the  former  cases.  The 
experiment  was  then  repeated  on  the  right  side, 
and  the  perforation  made  through  water  as 
before.  No  air  in  this  instance  escaped,  but  the 
water  was  immediately  sucked  into  the  chest  by 
the  atmospheric  pressure. 

EXPERIMENT     II. 

Artificial    respiration   was    produced    in    the 


240  CASES   OF   PNEUMOTHORAX. 

body  of  the  subject  of  Case  II.,  by  inflating 
the  lungs  through  the  trachea,  and  expelling 
the  air  by  pressure  on  the  abdomen.  At  each 
inflation,  a  most  distinct,  clear  and  abundant 
metallic  tinkling  was  produced,  accompanied 
with  more  or  less  amphoric  sound,  and  could  be 
sustained  ad  libitum  by  repeating  the  inflation. 
The  sound  was  recognized  by  several  of  the  med- 
ical gentlemen  attached  to  the  hospital,*  as  being 
the  same  which  had  existed  during  the  patient's 
life. 

This  experiment  was  repeated  in  the  examin- 
ation of  the  body  of  the  patient  in  Case  III. 
It  produced  amphoric  sound,  but  no  tinkling. 
The  latter  symptom,  it  will  be  observed,  was 
but  feebly  perceptible  in  examinations  during 
life. 

EXPERIMENT  m. 

Through  an  aperture  in  the  anterior  part 
of  the  chest  in  the  subject  of  Case  II.,  a 
catheter  was  introduced,  and  air  blown  through 
it  into  the  cavity  of  the  left  pleura.  While 

*  Among  the  gentlemen  present  were  Drs.  Hale,  Strong,  Bow- 
ditch  and  Sargent. 


EXPEKIMENTS.  241 

the  end  of  the  catheter  was  above  the  level 
of  the  fluid,  a  strong  amphoric  buzzing  was  com- 
municated to  the  ear  of  an  observer  in  con- 
tact with  the  chest.  But  when  the  end  of  the 
instrument  was  pushed  below  the  surface  of  the 
liquid,  and  the  latter  made  to  bubble  by  contin- 
uing the  inflation,  an  exquisite  metallic  tinkling 
was  heard  at  the  explosion  of  each  bubble  re- 
sembling, as  it  had  done  in  life,  the  sound  of  a 
little  bell  or  musical  wire.  In  the  subject  of 
Case  III.,  this  experiment  was  repeated,  and 
varied  by  pouring  into  the  chest  different  quan- 
tities of  water.  When  a  few  ounces  only  were 
present,  metallic  tinkling  was  uniformly  pro- 
duced, but  when  two  quarts  or  more  were  in- 
troduced, a  bubbling  only  was  heard,  without 
metallic  resonance.  Similar  results  were  also 
obtained  by  pouring  a  small  stream,  or  letting 
fall  drops  of  water  from  above  upon  the  liquid 
in  the  chest. 

EXPEKIMENT   IV. 

Succussion  and  percussion  were  both  found 
to   produce   the   same    metallic   sounds    in  the 
dead  body  as  during  life  in  Case  II.     Metallic 
21 


242  CASES    OF   PNEUMOTHORAX. 

sounds  elicited  by  percussion  somewhat  resem- 
ble those  occasionally  yielded  by  the  heart, 
and,  as  has  been  observed  by  Bouillaud,  these 
may  be  imitated  by  percussing  the  back  of  the 
hand  pressed  closely  upon  the  ear,  or  by  clos- 
ing both  ears  with  the  palms  of  the  hands,  and 
Avalking  on  a  carpet  in  a  still  room. 

EXPERIMENT   V. 

In  the  body  of  a  person  recently  dead  from 
accident,  having  no  pneumothorax,  a  repetition 
was  made  of  several  of  the  foregoing  trials. 
Air  and  water  were  forced  into  the  chest,  the 
former  so  as  to  distend  the  cavity  and  render 
percussion  quite  resonant.  Ebullition  of  the 
fluid  was  then  produced  by  blowing  through  a 
tube  inserted  between  the  ribs  and  pushed  below 
the  surface.  The  only  result  was  a  bubbling 
noise,  having  not  the  slightest  metallic  character. 
It  will  be  observed  that  this  was  nearly  a  repeti- 
tion of  Magendie's  experiment,  and  it  probably 
failed  to  produce  metallic  sound  for  the  same  rea- 
son as  in  that  case,  viz.,  that  the  patient  was  not 
pneumothoracic. 


REMARKS.  243 

EXPERIMENT  VI. 

A  bladder,  and  afterwards  a  stomach,  each 
containing  a  few  ounces  of  water,  were  in- 
flated until  thoroughly  distended.  Whenever 
the  inflating  tube  was  pushed  below  the ,  sur- 
face of  the  liquid,  and  the  inflation  continued 
so  as  to  produce  bubbles,  a  sharp  tinkling 
was  heard,  upon  the  explosion  of  every  bubble, 
by  the  ear  applied  as  in  ausculting  to  the  out- 
side of  the  bladder.  In  this  experiment  the 
sound  becomes  more  exquisitely  metallic  in  pro- 
portion as  the  tension  of  the  bladder  is  increased 
by  further  inflation.  Succussion  of  the  bladder 
produces  a  similar  effect.  It  is  necessary  that  a 
recent  bladder  should  be  used,  the  texture  and 
elasticity  of  which  are  not  altered  by  drying. 
"When  the  orifice  of  the  tube  is  above  the  sur- 
face of  the  water,  also  when  no  water  is  present 
in  the  bladder,  an  intense  amphoric  sound  is 
produced  during  inflation  ;  and  if  saliva  or  other 
liquid,  in  small  quantities,  is  blown  through  the 
inflating  tube,  a  more  feeble,  or  submetallic  tink- 
ling is  produced. 

From   the  foregoing   experiments   and   cases, 


244  CASES   OF  PNEUMOTHOKAX. 

we  may  infer  that  the  following  agencies  are 
concerned  in  producing  metallic  sounds  of  the 
chest. 

1.  There  must  be  a  cavity,  the  walls  of  which 
are  preternaturally  susceptible  of  vibration.    This 
takes  place  when  the  pleura  is  pathologically  dis- 
tended, so  as  to  overcome  the  obtuse  or  muffling 
effect  of  the  contiguous  soft  organs,  such  as  the 
lung,  diaphragm  and  intercostal  muscles.     Some 
time  is  probably  necessary  to  prepare  the  parts 
for  this  pathological  resonance,  since  it  fails  to 
appear  post  mortem  in  healthy  chests  submitted 
to  experiment.     It  should  be  added,  that,  when 
metallic  sounds  appear  in  simple  phthisis,  there 
are  cavities  of  the  lungs,  the  walls  of  which  are 
in  a  state  of  tubercular  induration. 

2.  The  immediate  or  exciting  cause  of  metallic 
tinkling  is  a  forcible  or  sudden  disturbance  of  the 
liquid  in  a  vibrating  cavity  like  that  described. 
The  explosion  of  bubbles  of  air,  from  beneath  the 
surface  of  the  liquid,  appears  to  be  the  most  com- 
mon cause  of  such  a  disturbance ;  but  it  may  also 
take  place  when  a  part  of  the  liquid  is  thrown 
upward  in  the  act  of  coughing  and  falls  back 


REMAKES.  245 

upon  the  remainder.   The  same  occurs  in  succus- 
sion  of  the  chest. 

3.  The  vibrations  which  yield  metallic  tink- 
ling are  transmitted  from  the  liquid  to  the  solid 
parietes,  and  thence  directly  to  the  ear,  without 
any  necessary  agency  of  an  echo,  or  reverber- 
ation of  air  in  the  cavity.      This  is  shown  par- 
ticularly by  the  experiment  of  the  bowl,  page 
218. 

4.  A  minor,  or  submetallic  tinkling,  having  no 
musical  resonance,  may  be  produced  by  slight  im- 
pulses given  to  the  air  in  the  cavity,  such  as  the 
breaking  of  bubbles  of  mucus  at  orifices  above 
the  surface  of  the  liquid. 

5.  Amphoric  resonance  is  produced  by  rever- 
berations of  the  air  in  a  vibrating  cavity,  without 
sonific  impulse  of  the  liquid.      The  same  is  true 
of  metallic  modifications  of  the  voice,  and  of  the 
cough  when  there  is  no  tinkling.      Metallic  per- 
cussion seems  also  to  depend  upon  the  vibrations 
of  air  independently  of  liquid,  and  may  be  pro- 
duced in  some  other  cases  when  we  strike  upon 
a  tense  cavity  in  which  a  certain  quantity  of  air 
is  confined. 

21* 


ON 

THE  PHARMACOPOEIA 

OF    THE 

UNITED    STATES    OF    AMERICA. 


[From  the  American  Journal  of  Medical  Sciences  for  1831.] 

IF  the  medical  and  scientific  world  were  re- 
stricted to  the  most  simple  modes  of  expression 
and  inter-communication,  —  if  we  possessed,  for 
example,  but  one  nosology,  but  one  system  of  natu- 
ral history,  but  one  language  of  chemistry  and 
pharmacy,  —  it  is  obvious  that  the  books  which 
treat  of  those  sciences  would  be  greatly  simpli- 
fied; that  the  labor  of  learners  would  be  abridged, 
and  much  confusion  prevented  among  those  who 
respectively  teach  or  cultivate  these  departments 
of  knowledge.  Of  this  fact  the  public  are  so  well 
aware,  that  attempts  have  been  many  times  made 
to  establish  in  these  sciences  standards  of  definite 
expression.  Sometimes  under  the  sanction  of 


PHAEMACOPCEIA   OP  THE   UNITED   STATES.       247 

governments,  sometimes  from  the  influence  of 
popular  writers  or  teachers  in  science,  and  some- 
times from  the  conventional  authority  of  dele- 
gated bodies,  a  common  language  has  been  intro- 
duced, and  obtained  a  degree  of  currency,  which, 
though  seldom  universal,  has,  nevertheless,  been 
sufficiently  extensive  to  produce  a  full  proof  and 
conviction  of  its  utility. 

Unhappily,  however,  in  those  studies,  the  sub- 
jects of  which  are  most  multifarious  and  com- 
plex, and  which  therefore  stand  most  in  need  of 
precision  in  their  nomenclatures,  an  inexplicable 
confusion  of  language  still  exists.  Mineralogy, 
zoology,  and  botany,  particularly  the  two  latter, 
in  themselves  no  trifling  subjects  of  labor,  have 
been  rendered  to  most  persons  absolutely  insur- 
mountable, by  the  cumbrous  load  of  synonyms, 
which  has  been  gradually  accumulating  upon 
them,  under  the  agency  of  successive  reformers. 
The  Latin  language,  once  the  common  medium 
of  intercourse  for  the  learned  of  all  countries, 
has  itself  become  a  sort  of  Babel,  furnishing,  not 
unfrequently,  a  dozen  incongruous  names  for  the 
same  object.  And  since  neither  Napoleon  nor 
Nicholas,  nor  any  general  congress  for  the  paci- 


248  ON   THE  PHARMACOPOEIA 

fication  of  Europe,  has  taken  in  hand  the  recon- 
ciliation of  conflicting  terminologies,  the  repub- 
lic of  names  still  remains  at  the  mercy  of  every 
innovator  whose  new  colors  may  attract  partisans 
and  disciples,  and  increase  the  anarchy  already 
existing. 

It  is,  therefore,  sufficiently  evident  that  the 
language  of  the  sciences  which  we  have  men- 
tioned needs  retrenchment  quite  as  much  as  ex- 
tension ;  and  were  it  not  for  the  fact  that  certain 
nomenclatures  have  become  incorporated  with 
books  more  useful  than  themselves,  it  would  be 
a  happy  circumstance,  if  all  of  them,  save  one, 
could  be  consigned  to  oblivion.  To  determine 
what  one  in  each  particular  case  should  super- 
sede all  the  rest,  might  be  as  delicate  an  affair 
as  to  elect  a  president  of  the  United  States. 
But  it  is  not  the  less  true,  that  one,  even  though 
deficient  and  unacceptable,  would  be  far  better 
than  ^nany. 

Pharmacology,  considered  not  only  as  a  sci- 
ence, but  as  a  medium  of  communication  for 
two  extensive  professions,  particularly  needs  sim- 
plicity and  precision  of  language.  It  likewise 
requires  that  its  expressions  should  be  generally 


OF   THE   UNITED   STATES.  249 

intelligible,  an  advantage  which  cannot  be  se- 
cured, except  by  the  introduction  of  a  general 
standard,  regulating  the  names  as  well  as  the 
selection  and  modification  of  its  subjects.  On 
this  ground,  it  is  presumed,  there  is  no  vari- 
ance of  opinion.  But  when  we  arrive  at  the 
question,  what  the  standard  shall  be,  and  who 
shall  appoint  it,  the  charm  of  unanimity  is  very 
apt  to  dissolve. 

It  is  not  difficult  to  frame  a  competent  phar- 
macopoeia, which  shall  be  abundantly  adequate 
to  the  wants  of  the  medical  community.  But  to 
devise  a  plan  by  which  its  general  adoption  shall 
be  secured,  is  a  task  which  experience  has 
proved  to  be  attended  with  no  ordinary  diffi- 
culty. Local  partialities,  and  an  unwillingness 
to  receive  the  supposed  dictation  of  others,  have 
in  more  cases  than  one  frustrated  the  best  con- 
trived plans  for  promoting  a  general  accommo- 
dation. And  since  indisputable  perfection  is  not 
to  be  expected  in  a  pharmacopoeia,  there  will 
always  be  found  a  spirit  of  hypercriticism,  ready 
to  consider  trivial  defects  as  reasons  for  reject- 
ing a  public  good. 

We  hold  it  to  be  a  maxim,  that  one  standard 


250  ON   THE  PHARMACOPOEIA 

of  pharmacy,  if  sanctioned  throughout  a  whole 
country,  even  though  it  be  an  imperfect  one,  is 
far  more  promotive  of  public  convenience  than 
a  number  of  more  learned  and  perfect  ones  ex- 
isting simultaneously.  The  late  autocrat,  Alex- 
ander, ordered  his  Scotch  body-surgeon,  Sir 
James  Wylie,  to  prepare  a  Pharmacopoeia  Ros- 
sica,  which  he  introduced  by  an  ukase  through- 
out his  extensive  dominions.  This  work,  a  copy 
of  which  has  reached  us,  appears  to  be  suffi- 
ciently respectable.  But,  without  entering  into 
its  particular  merits  or  demerits,  we  will  venture 
to  presume  that  the  subjects  of  his  hyperborean 
majesty  have  been  enabled  to  compound  and 
swallow  their  drugs  with  equal  effect,  and  far 
less  trouble,  than  those  of  the  king  of  Great 
Britain,  speaking  in  the  tongues  of  three  differ- 
ent colleges. 

If  the  business  of  making  a  pharmacopoeia 
could  be  commenced  de  novo,  without  reference 
to  any  of  the  standards  now  existing,  the  great 
question  presented  with  regard  to  nomenclature 
would  be,  whether  names  should  be  scientific, 
that  is,  in  some  measure  descriptive  of  the  origin, 
character,  and  composition  of  medicines;  or 


OF   THE  UNITED   STATES.  251 

whether  they  should  be  arbitrary,  having  no 
such  reference  or  import.  In  the  former  case, 
the  names  would  be  more  expressive,  and  better 
suited  to  the  dignity  of  science ;  in  the  latter 
they  would  be  more  permanent,  from  not  being 
connected  with  any  fluctuating  medium. 

To  illustrate  these  positions,  let  us  observe  the 
revolution  through  which  a  single  substance  has 
been  obliged  to  pass,  in  order  to  keep  pace  with 
the  progress  and  improvements  of  science. 
Since  the  discovery  of  calomel,  that  article  has 
been  reformed  by  at  least  a  score  of  successive 
appellations.  In  the  figurative  language  of 
alchemy  it  was  known  by  the  names  of  draco 
mitigatus,  aquila  alba,  manna  metallorum,  &c. 
As  chemistry  grew  somewhat  more  definite  as 
a  science,  this  substance  becomes  mercurius 
dulcis,  and  mercurius  dulcis  sublimatus.  Under 
the  regime  of  Lavoisier  and  his  cotemporaries, 
it  was  a  muriate  and  a  submuriate ;  and  after 
Davy  and  Gay  Lussac,  became  a  chloride  and  a 
proto-chloruret,  Lastly,  as  if  the  gentleness  of 
its  character  was  to  produce  a  reconciliation  of 
extremes,  the  mitigated  dragon  of  antiquity  has 
become  a  mild  chloride  of  mercury. 


252  ON   THE   PHAKMACOPCEIA 

On  the  other  hand,  when  a  nomenclature  has 
been  perfectly  arbitrary  and  divested  of  scientific 
relations,  it  has  been  proportionally  durable  and 
constant.  Like  the  words  engrafted  on  a  na- 
tional language,  its  origin  may  be  vague  and 
accidental,  yet  the  public  convenience  prevents 
it  from  falling  into  disuse ;  and  though  it  might, 
perhaps,  be  susceptible  of  reform,  yet  the  benefit 
would  not  compensate  the  trouble.  In  regard  to 
pharmacology,  there  is  one  language  alone  which 
has  remained  permanent  amidst  mutations,  and 
which  a  hundred  years  have  not  been  able  to 
shake  from  its  basis,  —  we  mean  the  language 
of  commerce.  This  language,  which  is  for  the 
most  part  arbitrary  and  accidental,  has  seen 
many  pharmacopoeias  rise  and  fall,  and  is  now 
quite  as  likely  as  any  one  of  them  to  last  for  a 
century  to  come.  The  simple  names  of  opium 
and  alum,  of  calomel  and  camphor,  have  never 
yielded  to  any  periphrastic  method  of  expressing 
the  same  things.  Corrosive  sublimate  refuses  to 
be  modernized,  and  the  salts  of  Epsom  and 
Eochelle  maintain  their  ground  against  all  chem- 
ical interference.  The  combined  learning  of  two 
hemispheres  is  unable  to  prevail  against  copperas 


OF   THE   UNITED   STATES.  255 

and  cream  of  tartar,  and  the  manufacturer  and 
merchant  still  continue  to  make,  sell,  and  buy 
their  tartar  emetic,  without  troubling  themselves 
to  inquire  whether  it  is  a  "  tartrate,"  or  a  "  cream 
tartrate,"  or  neither.  Nay,  in  some  instances,  the 
vulgar  appellations  have  turned  the  tables  upon 
the  classical  and  scientific,  and  the  homely  name 
of  potash  has  dictated  to  the  learned  their  more 
elegant  potass  and  potassium. 

To  combine  in  practice  the  expressiveness  and 
precision  of  one  language  with  the  durability  of 
the  other,  though  very  desirable,  would,  from  the 
nature  of  the  subject,  be  impossible.  Yet  an  ap- 
proach may  be  made  to  the  advantages  of  both, 
by  adopting,  in  the  first  instance,  a  descriptive 
language  founded  on  the  existing  state  of  science 
at  the  time,  and  afterwards  to  declare  it  per- 
petual, or  at  least  to  establish  it  in  force  during  a 
long  term  of  years.  We  should  thus  possess  a 
medium  of  communication  in  itself  entitled  to 
respect,  and  rendered  more  valuable  by  the  pros- 
pect of  being  permanent. 

It  appears  to  us  that  the  stability  of  pharma- 
ceutical language  is  a  consideration  of  quite  as 
much  importance  as  its  improvement.  Great 
22 


254  ON  THE  PHARMACOPCEIA 

changes  in  regard  to  any  prevalent  system  can 
seldom  be  effected  without  doing  violence  to 
established  habits  and  preferences  of  the  com- 
munity. An  apothecary,  whose  drawers  are 
labelled  with  the  legitimate  nomenclature  of  the 
day,  and  a  physician,  who  for  a  score  of  years 
has  employed  a  uniform  phraseology  in  his  pre- 
scriptions, are  not  compensated,  by  any  trifling 
advantage,  for  the  risk  and  trouble  of  an  entire 
change.  Wherever,  therefore,  it  appears  that  a 
uniform  system  is  extensively  established  in  any 
country,  it  is  incumbent  on  the  friends  of  science 
to  oppose  all  unnecessary  deviation  from  the 
rules  it  prescribes.  If  the  general  progress  of 
other  sciences  has  been  such  as  to  require  that 
pharmacy  should  be  made  to  keep  pace  with 
them,  its  improvement  ought  to  consist  as  far  as 
possible  in  additions,  synonyms,  and  commen- 
taries, but  not  in  great  or  violent  changes.  It  is 
fortunate  for  the  science  of  anatomy  that  its  dis- 
tinctive names  have  been  handed  down  from  one 
generation  to  another  with  so  little  alteration ; 
and  we  believe  no  reformer  at  the  present  day 
would  obtain  many  proselytes,  who  should  pro- 
pose to  abolish  its  nomenclature,  because  pia 


OF   THE  UNITED   STATES.  255 

mater,  os  sacrum,  ossa  innominata,   and  similar 
names,  are  absurd,  misplaced,  or  unscientific. 

In  regard  to  preparations  or  compositions,  it 
may  often  happen  that  improvements  are  neces- 
sary in  pharmacy,  to  promote  the  economy  and 
uniformity  of  certain  results.  Such  changes  are 
highly  proper,  provided  they  do  not  interfere 
materially  with  the  standard  of  strength  which 
has  been  previously  current.  But  great  changes 
in  the  strength  of  medicines  may  generally  be 
regarded  as  pernicious,  serving  to  perplex  apoth- 
ecaries and  deceive  physicians,  if  not  to  kill 
patients.  It  is  to  be  regretted  that,  in  the  differ- 
ent pharmacopoeias  which  have  been  published 
among  us,  there  are  operative  medicines  bearing 
the  same  name,  in  some  of  which  the  strength  is 
double  that  of  others.  As  to  the  more  complex 
medicinal  formulae  which  crowd  our  books,  it  will 
be  found  that  most  of  them  owe  their  place  in 
the  shops  to  some  fashion,  or  some  traditional 
celebrity,  rather  than  to  any  exclusive  fitness  or 
virtue ;  and  we  may  perhaps  get  a  true  idea  of 
their  value  from  the  consideration,  that  if,  by 
any  means,  the  knowledge  of  the  whole  of  them 
should  be  lost,  it  is  not  probable,  in  the  doc- 


256  ON  THE   PHARMACOPOEIA 

trine  of  chances,  that  one  in  fifty  would  ever  be 
reinvented.  Yet,  since  the  prevailing  traffic  re- 
quires that  they  should  continue  to  be  made  and 
sold,  it  is  important,  for  those  who  consume 
them,  that  they  should  be  exempt  from  fluctua- 
tions of  character. 

In  the  United  States,  previous  to  1820,  there 
was  no  uniformity  of  pharmaceutical  language. 
Pharmacopoeias,  indeed,  had  been  adopted  by 
medical  bodies,  in  Massachusetts  and  some  of  the 
other  States ;  and  Dispensatories,  both  foreign 
and  native,  had  been  published  among  us.  But, 
in  the  year  referred  to,  an  effort  was  made,  by 
which  the  consent  of  a  great  majority  of  the 
medical  institutions  of  the  country  was  obtained, 
for  a  plan  of  a  national  pharmacopoeia.  This,  it 
was  confidently  hoped,  by  introducing  a  current 
language  throughout  the  country,  would  do 
away  the  confusion  which  then  prevailed,  and 
offered  to  the  parties  concerned  a  facility  of 
intercommunication,  corresponding  to  that  which 
results  from  a  common  system  of  coinage,  or  of 
weights  and  measures.  A  numerous  and  highly 
respectable  delegation  was  appointed,  from  most 


OF   THE   UNITED   STATES.  257 

of  the  principal  States,  a  part  of  whom  met  in 
the  city  of  Washington,  at  the  appointed  time. 

It  may  here  be  proper  to  inquire  what  such  a 
convention  could  reasonably  be  expected  to  do, 
and  what  it  was  their  duty  to  do,  under  the  cir- 
cumstances in  which  they  were  placed.  Coming 
together  from  remote  places,  and  holding  their 
session  at  an  inconvenient  sacrifice  of  time  and 
expense,  it  was  not  to  be  anticipated  that  they 
would  institute  an  original  investigation  of  the 
whole  subject.  The  ordeal  of  an  experiment 
upon  every  doubtful  subject  would  have  in- 
volved a  labor  of  months,  and  perhaps  of  years. 
It  would  not  reasonably  be  expected  that  they 
would  produce  a  pharmacopoeia  which  should  be 
better  than  any  which  previously  existed.  A 
debating  assembly  would  be  far  less  likely  to  do 
this  than  a  competent  individual  in  his  closet. 
Yet  the  convention  possessed  the  power  to 
confer  a  great  good,  —  a  power  which  no  indi- 
vidual is  likely  to  obtain, —  that  of  introducing 
order  in  the  place  of  confusion,  and  law  instead 
of  anarchy. 

Under  these  circumstances,  it  was  incumbent 
on  them  to  produce,  or  sanction,  some  standard 
22* 


258  ON  THE   PHARMACOPOEIA 

of  pharmacy  which  should  be  adequate  to  the 
wants  of  the  community.  It  was  not  very  mate- 
rial what  one,  among  many  standards,  they 
should  adopt  as  their  basis.  They  might  have 
selected  the  Edinburgh  Pharmacopoeia,  which, 
though  prolix  in  its  expressions,  was  at  that 
time  more  current  than  any  other  in  the  coun- 
try. Or  they  might  have  taken  the  London 
Pharmacopoeia,  dogged  as  it  has  been  by  Mr. 
Phillips,  and  this  would  have  served  very  well  as 
the  groundwork  of  a  useful  book.  Or  they  might 
endeavor  to  frame  a  system  of  their  own,  which, 
in  some  respects,  might  be  superior  to  its  pre- 
decessors, or  at  least  better  adapted  to  the  cus- 
toms and  wants  of  our  own  country.  The  last 
plan  was  decided  on  by  the  convention,  under 
the  expectation,  doubtless,  that  it  would  be  more 
acceptable  to  their  constituents.  A  programme 
of  a  pharmacopoeia  prepared  by  the  College  of 
Physicians  in  Philadelphia,  was  adopted  as  the 
groundwork,  and,  after  being  variously  modified 
and  augmented,  was  referred  to  a  committee, 
with  instructions  to  publish  it. 

It  must  necessarily  happen  that  a  work  ema- 
nating  from   so   many  disconnected   sources,  a 


OF  THE  UNITED   STATES.  259 

part  of  whose  contents  must,  from  the  nature  of 
the  case,  be  the  result  of  compromise  among  the 
parties  concerned,  rather  than  of  satisfaction  to 
any  of  them,  would  be  in  some  respects  imper- 
fect, disconnected,  and  redundant.  Neverthe- 
less, if  it  was,  on  the  whole,  better  suited  to  the 
occasion  than  any  other  work  actually  existing, 
the  public  were  bound  to  receive  it  with  com- 
placency, as  the  only  standard  which  could  ever 
become  general  among  us.  And  if  criticisms 
were  needed  to  point  out  the  faults  which  it  con- 
tained, they  should  have  been  made  in  a  spirit 
of  manliness  and  liberality,  such  as  would  have 
promoted  the  gradual  reform  and  perfection, 
rather  than  the  overthrow  of  the  work.  But 
several  of  the  journals  thought  otherwise,  and 
the  pharmacopoeia  was  obliged  to  undergo  an 
ordeal,  the  severity  of  which  far  exceeded  its 
deserts.  The  spirit  of  criticism  was  pushed  with 
a  zeal  not  according  to  knowledge,  and  in  many 
instances  the  ignorance  of  the  commentator, 
rather  than  the  defects  of  the  book,  produced  a 
reprobation  of  its  contents.  Nevertheless,  the 
pharmacopoeia  was  received,  willingly  by  some, 
and  reluctantly  by  others,  and  became,  we  have 


260  ON  THE  PHARMACOPOEIA 

reason  to  believe,  the  prevailing  standard,  or  at 
least  more  prevalent  than  any  other  throughout 
the  United  States. 

It  was  to  be  hoped  that,  when  the  period 
should  arrive  which  had  been  assigned  by  the 
convention  for  a  revision  of  this  work,  a  suffi- 
cient unanimity  of  sentiment  would  have  pre- 
vailed to  direct  into  one  channel  whatever 
amount  of  skill  and  experience  might  be  volun- 
teered for  its  improvement,  either  by  societies 
or  individuals.  It  appears  that  numerous  socie- 
ties, in  different  parts  of  the  Union,  feeling  an 
interest  in  the  revision  and  confirmation  of  the 
pharmacopoeia,  had  appointed  delegates  to  attend 
the  expected  convention  at  Washington,  in  1820. 
A  part  of  the  delegates  thus  designated  were, 
agreeably  to  the  provisions  made  in  1820,  re- 
turned to  the  presiding  officer  of  that  year.  But 
a  greater  number,  who  had  not  been  formally 
returned,  proceeded  to  "Washington  at  the  ap- 
pointed time,  and  having  organized  a  convention 
of  such  delegates  as  were  present,  and  invited  a 
cooperation  of  other  medical  gentlemen  of  emi- 
nence then  in  the  city,  proceeded  to  take  meas- 
ures for  the  republication  of  the  work.  In  the 


OP  THE   UNITED  STATES.  261 

mean  time,  a  part  of  the  delegates  who  had  been 
officially  returned  to  the  former  president,  influ- 
enced either  by  convenience,  or  by  the  smallness 
of  their  numbers,  determined  not  to  convene  at 
Washington,  but  held  a  meeting  in  New  York, 
whore  they  also  proceeded  to  take  measures  for 
republishing  the  pharmacopoeia,  having  likewise 
invited  the  cooperation  of  other  medical  gentle- 
men of  note.  Out  of  this  want  of  concord  have 
risen  up  two  pharmacopoeias,  neither  of  which 
can  strictly  claim  to  be,  by  lineal  descent,  the 
legitimate  heir  of  the  original  work ;  one,  pro- 
ceeding from  a  body  not  formally  declared 
elected  to  the  convention  at  Washington ;  the 
other,  from  a  body  who  did  not  convene  at 
Washington  at  all.  We  regret,  during  the  long 
period  of  preparation,  in  which  the  proceedings 
of  each  party  must  have  been  known  to  the 
other,  at  least  in  a  degree,  that  some  compromise 
was  not  effected,  so  that  the  objects  of  both 
might  be  attained,  with  less  trouble  to  them- 
selves, and  less  expense  to  the  public.  It  was 
not,  indeed,  in  the  power  of  the  delegates  at 
Washington  to  correct  the  original  defect  in 
their  mode  of  election,  but  it  was  in  the  power 


262  ON  THE   PHARMACOPOEIA 

of  the  delegates  of  New  York  to  have  gone  to 
"Washington,  and  there  to  have  invited  the  coop- 
eration of  the  other  delegates  present,  especially 
as  they  appear  not  to  have  been  afterwards  fas- 
tidious in  associating  with  their  own  body  undel- 
egated  individuals.  Even  after  the  original  meet- 
ings had  taken  place,  a  slight  spirit  of  conciliation 
in  one  or  both  parties  (we  know  not  which  was 
wanting  in  this  respect)  would  have  produced 
harmony  and  unity  in  the  end. 

As  things  now  are,  it  appears  to  us  that  the 
two  works  must  stand  upon  their  respective 
merits  as  pharmaceutic  compositions ;  and  the 
public  are  called  on  to  decide  whether  either, 
and,  if  either,  which  one,  is  entitled  to  be  re- 
ceived as  the  national  standard.  And  here,  if  it 
be  asked  what  constitutes  fitness  or  excellence 
in  a  pharmacopoeia,  we  should  answer,  simply, 
that  such  a  work  ought  to  contain  and  identify 
the  medicines  which  are  commonly  used  by  phy- 
sicians, that  its  preparations  should  be  scientifi- 
cally composed,  that  its  language  should  conform 
to  the  most  current  language  of  the  day,  and  that 
it  should  be  complete  as  a  system  in  itself,  that 
is,  should  have  a  correspondence  between  its 


OF  THE  UNITED   STATES.  263 

own  parts.  In  these  respects  we  think  the 
Washington  Pharmacopoeia  has  greatly  the  ad- 
vantage of  its  competitor.  We  observe  in  its 
list  of  materia  medica,  comparatively  few  altera- 
tions of  names,  and  these  are  made  mostly  in 
conformity  to  the  present  language  of  chemis- 
try. In  the  New  York  edition  the  changes  are 
exceedingly  numerous,  the  new  names  being 
taken  partly  from  the  London  Pharmacopoeia, 
and  partly  invented  for  the  occasion,  so  that  the 
book  has  the  aspect  of  an  edition  of  some  other 
work,  rather  than  of  the  American  Pharmaco- 
poeia. The  references  to  authors,  which  are 
considered  necessary  by  most  pharmacologists, 
to  identify  the  substances  intended,  are  wholly 
omitted  in  this  work.  In  regard  to  complete- 
ness and  accuracy,  the  work  of  the  Washington 
convention  is  prepared  with  much  care  and  sci- 
ence, and  with  a  correspondence  of  its  different 
parts.  In  the  New  York  edition  we  find  a  want 
of  unity,  such  as  attends  hasty  preparations,  and 
a  discordance  often  recurring  between  the  names 
of  the  articles  themselves  and  those  of  their  prep- 
arations. 

In  regard  to  the  latter  work,  knowing  the  diffi- 


264  ON   THE   PHAEMACOPCEIA 

culties  which  attend  this  species  of  composition, 
and  entertaining  a  high  respect  for  the  character 
of  the  gentlemen  concerned,  we  forbear  to  fill 
our  pages  with  commentaries  on  its  redundan- 
cies and  discrepancies.  We  shall  not  therefore 
complain  because  Burgundy  pitch  is  inserted 
twice  under  different  names,  in  the  materia 
medica,  nor  because  the  sulphates  of  quinine  and 
morphine,  figs,  prunes,  and  some  other  articles 
required  in  the  preparations,  are  not  inserted  in 
the  materia  medica  at  all.  These  things  must  be 
corrected  with  their  pens  by  those  who  may  em- 
ploy the  book.  On  the  other  hand,  we  are  happy 
to  perceive  some  improvements  on  the  edition 
of  1820,  in  the  greater  accuracy  of  the  chemical 
nomenclature,  and  in  the  introduction  of  some 
useful  formulas.  We  think,  however,  that  re- 
trenchment in  the  old  work  was  much  more 
needed  than  augmentation. 

Believing  that  the  pharmacopoeia  produced  by 
the  Washington  convention,  being  a  more  elabo- 
rate, accurate  and  finished  work,  will  eventually 
become  the  standard  of  the  country,  we  propose 
to  enter  somewhat  more  at  large  into  the  consid- 
eration of  its  contents.  This  we  shall  endeavor 


OP  THE  UNITED   STATES.  265 

to  do  with  the  impartiality  which  the  subject 
ought  to  receive. 

In  their  preface  this  convention  express  their 
reasons  for  adopting  as  their  basis  the  Pharma- 
copoeia of  1820,  a  work  having  many  inconven- 
iences and  defects,  but  at  the  same  time  many 
claims  to  approval.  In  its  general  outline,  say 
they,  and  prominent  features,  it  will  bear  a  favor- 
able comparison  with  the  best  pharmacopoeias  of 
Europe,  and  it  is  only  in  filling  up,  that  improve- 
ment is  demanded,  or  admissible.  The  changes, 
therefore,  which  have  been  made  under  the  au- 
thority of  the  late  convention,  embrace  the  mate- 
rials and  minor  arrangements,  without  extending 
to  the  general  plan.  In  preparing  for  the  press 
the  present  revised  edition,  the  new  convention 
inform  us  that  much  labor  has  been  expended, 
and  every  part  of  the  work  submitted  to  the 
most  strict  and  rigid  scrutiny.  Every  accessible 
pharmaceutic  authority  has  been  consulted,  and 
the  accuracy  of  processes  has  been  frequently 
tested  by  a  practical  investigation  j  the  several 
departments  have  engaged  the  attention  of  indi- 
viduals peculiarly  qualified  by  their  previous 
studies,  and  the  whole  has  passed  the  examina- 
23 


266  ON    THE    PHARMACOPOEIA 

tion  of  pharmaceutists  of  acknowledged  eminence 
in  their  profession. 

Considering  how  difficult  it  is  to  induce  per- 
sons of  the  necessary  competency  to  engage  in 
gratuitous  labors  with  perseverance  and  fidelity, 
we  are  happy  that  the  individuals  concerned  in 
the  present  revision  have  devoted  themselves 
with  such  singleness  of  purpose  to  the  perfect- 
ing of  the  work.  From  our  knowledge  of  the 
amount  of  labor  actually  bestowed  on  it,  and 
from  the  internal  evidences  which  it  bears  of 
extensive  inquiry  and  precise  examination,  we 
doubt  whether  any  future  convention  will  pre- 
sent us  with  results  more  deserving  of  the  public 
confidence. 

In  pursuance  of  the  plan  of  the  former  edition," 
and  for  reasons  which  it  is  not  necessary  here  to 
repeat,  the  pharmacopoeia  is  written  out  on  oppo- 
site pages  in  Latin  and  in  English.  The  classical 
latinity  of  the  London  Pharmacopoeia  is  adopted 
as  a  standard,  and,  by  keeping  this  in  view,  a 
unity  of  style  is  preserved  throughout  the  book. 
We  see  no  cause  to  be  dissatisfied  with  the  gen- 
eral purity  and  elegance  of  this  language,  though 
in  one  case,  we  observe,  the  convention  have 


OF  THE  UNITED  STATES.          267 

erroneously  followed  the  London  example,  in 
using  the  genitive  "  rosmarini,"  and  ablative 
"  rosmarino,"  instead  of  the  undoubted  rorisma- 
rini,  and  roremarino,  sanctioned  by  Horace, 
Columella,  and  other  classics. 

In  regard  to  names,  the  convention  inform  us 
in  their  preface,  that,  for  reasons  which  they  dis- 
cuss at  length,  they  have  adopted  the  modern 
chemical  nomenclature,  in  which  the  names  are 
expressive  of  the  composition  of  bodies.  This 
was  in  most  cases  done  by  the  framers  of  the 
former  pharmacopoeia,  but  in  the  present  edition 
an  attempt  has  been  made  to  bring  the  nomencla- 
ture more  completely  in  accordance  with  the 
best  scientific  usage.  Thus  we  have  chloride  of 
sodium,  instead  of  muriate  of  soda ;  ferrocyanate 
of  iron,  instead  of  prussiate  of  iron,  &c.  In  a 
few  instances,  however,  to  avoid  great  circumlo- 
cution, a  pharmaceutical  name  is  retained  in  the 
place  of  a  more  expressive  chemical  appellation, 
as  in  the  case  of  alumen,  hydrargyrum  ammonia- 
turn,  &c.  In  conformity  with  the  present  lan- 
guage of  chemistry,  the  proportional  composi- 
tion of  bodies,  it  appears,  is  intended  to  be 
expressed,  and  we  have,  among  other  things,  a 


268  ON  THE   PHARMACOPOEIA 

bicarbonate  of  potass,  and  a  bicarbonate  of  soda. 
But  this  intention  is  not  always  executed  through- 
out the  work,  which  seems  to  us  a  defect  in  uni- 
formity. The  substance  called  by  this  conven- 
tion sulphate  of  copper  is  a  bisulphate,  and  ought 
so  to  be  called  in  a  chemical  nomenclature,  since 
there  is  another  sulphate,  composed  of  one  equiv- 
alent of  acid  and  one  of  peroxide  of  copper, 
which  is  precipitated  by  adding  pure  potass  to 
the  solution  of  the  bisulphate  above  mentioned, 
in  a  quantity  insufficient  for  separating  the  whole 
of  the  acid. 

We  know  not  for  what  reason  it  has  been 
thought  proper  to  omit,  as  synonyms,  certain  com- 
mercial names  of  common  usage,  while  others,  of 
much  less  frequent  occurrence,  are  retained.  The 
student  of  pharmacy  who  would  know  what  is 
meant  by  Epsom  salt,  Glauber's  salt,  blue  vitriol, 
and  other  names  which  meet  him  in  the  daily 
price  current,  must  seek  for  information  in  other 
books  than  the  American  Pharmocopceia.  These 
names  being  international  and  long  established, 
cannot,  we  think,  with  propriety,  be  given  up  in 
a  work  of  general  pharmacy. 

In  the   nomenclature   of    substances   derived 


OF   THE    UNITED   STATES. 


from  the  vegetable  kingdom,  the  work  before 
us  adheres  to  the  simple  and  appropriate  plan 
of  the  first  edition,  that  of  using,  in  all  practica- 
ble cases,  a  single  word  for  the  name  of  the  drug, 
leaving  its  nature  and  origin  to  be  defined  in  the 
opposite  column.  This  peculiarity  of  the  Ameri- 
can Pharmacopoeia  is  one  of  its  leading  excel- 
lences, and  one  which  the  New  York  convention 
seem  to  have  acted  unwisely  in  abandoning. 
Most  of  the  names  used  in  other  pharmacopoeias, 
to  express  vegetable  substances,  are  either  un- 
wieldy in  their  length,  or  improper  in  their  appli- 
cation. Thus  the  drug  assafcetida  is  called  by 
the  Edinburgh  college,  gummi  resina  ferulee  assa- 
fostidse,  a  name  which  is  highly  descriptive,  but 
inapplicable  to  common  use.  By  the  London 
college  it  is  called  assafcetidse  gummi  resina ;  but 
as  the  term  assafcetida  alone  is  not  the  name  of 
any  plant,  in  any  botanical  system  of  the  present 
day,  the  whole  name  is  incorrectly  composed. 
The  simple  name  of  the  drug,  assafoetida,  is 
undoubtedly  better  than  either.  In  like  manner 
columbo  may  be  called  by  the  simple  name  co- 
lomba,  or  by  the  circuitous  name  cocculi  pal- 
mata  radix,  but  not  calumbse  radix,  for  there  is 
23* 


270  ON   THE   PHARMACOPOEIA 

no  such  plant  as  calumba.  The  American  Phar- 
macopoeia has  another  advantage  in  using  simple 
names,  whenever  the  drug  happens  to  be  derived 
from  several  plants,  as  camphor,  senna,  rheum, 
and  aloe,  or  from  several  animals,  ichthyocolla. 
In  the  present  edition  a  slight  variation  is  made 
from  the  former,  in  using  the  Latin  name  of  the 
article  always  in  the  singular  number,  as  cantha- 
ris,  caryophyllus,  prunum,  instead  of  cantharides, 
&c.  This  method  preserves  uniformity,  and  is 
supported  by  the  usage  of  Celsus  in  similar 
cases. 

As  in  the  former  edition,  the  materia  medica 
list  is  divided  into  two  columns,  the  first  of 
which  contains  the  officinal  name  of  each  article, 
in  Latin  and  English,  together  with  occasional 
synonyms,  while  the  other  defines  the  substance 
intended,  and  gives  explanatory  references. 
This  part  of  the  work  gives*  evidence  of  a  laud- 
able degree  of  care  and  research,  yet  we  notice 
a  few  minor  things  deserving  of  remark.  The 
substance  called  lupulin,  derived  from  the  hop,  is 
defined  "strobilorum  pollen."  As  the  word 
pollen  has,  in  vegetable  physiology,  a  specific 
meaning,  it  would  have  been  better  to  have  used 


OP   THE    UNITED    STATES.  271 

some  other  name  to  express  powder.  In  the 
Latin,  lupulia,  as  -used  by  the  New  York  con- 
vention, is  more  consonant  to  morphia  and 
quinia  than  lupulina.  We  see  no  reason  for 
giving  up  spermaceti,  the  universally-received 
name,  both  in  chemistry  and  commerce,  and  sub- 
stituting cetaceum  of  the  London  college,  a  word 
which  is  neither  more  classical  nor  more  de- 
finitive. Scabious,  applied  to  erigeron,  is  a 
provincial  misnomer,  that  name  belonging  only 
to  scabiosa. 

In  regard  to  the  preparations,  the  convention, 
considering  this  the  most  extensive  and  impor- 
tant part  of  the  work,  have  devoted  to  it  a  greater 
share  of  their  attention.  They  inform  us  that 
examination  has  been  carried  into  all  its  parts, 
and  not  a  single  process  has  been  allowed  to 
escape  a  close  scrutiny.  One  of  the  most  promi- 
nent defects  of  the  original  pharmacopoeia  was  a 
want  of  uniformity,  both  in  the  manner  of  con- 
ducting the  processes,  and  in  the  style  of  de- 
scribing them.  This  arose  from  the  variety  of 
sources  from  which  materials  were  drawn,  and 
the  want  of  due  time  to  remould  and  shape 
them,  so  as  to  produce  a  harmonious  whole.  In 


272  ON   THE   PHARMACOPEIA 

the  present  edition  an  effort  has  been  made  to 
supply  these  deficiencies,  and  to  produce  uni- 
formity of  language,  as  well  as  correspondence 
and  unity  of  design,  in  the  different  parts  of  the 
work.  In  the  selection  of  the  process  for  each 
preparation,  two  principles  are  stated  to  have 
governed  the  choice  of  formulae,  independent  of 
their  intrinsic  merit,  which,  when  superior,  has 
always  been  allowed  a  predominating  influence. 
When  two  or  more  methods  of  preparing  the 
same  compound,  equally  meritorious  in  them- 
selves, have  come  under  consideration,  that  has 
been  preferred  which  has  united  in  its  favor  the 
widest  prevalence  in  this  country,  and  the  sanc- 
tion of  the  majority  of  the  British  pharmacopoeias. 
It  is  considered  highly  desirable  that  uniformity 
in  the  preparation  of  medicines  should  every- 
where prevail,  for  the  benefits  accruing  from  the 
mutual  interchange  of  the  medical  writings  of 
different  civilized  nations  must  be  greatly  af- 
fected by  any  material  difference  in  the  nature 
or  composition  of  the  remedies  employed.  This 
remark  is  especially  applicable  to  Great  Britain 
and  the  United  States,  and  to  all  countries  where 
the  English  language  is  generally  used.  It  is  a 


OP  THE   UNITED   STATES.  273 

duty,  therefore,  say  the  convention,  which  we 
owe  to  the  cause  of  pharmacy,  to  throw  our 
weight  into  the  scale  which  already  preponder- 
ates, and  thus  contribute  to  the  production  and 
maintenance  of  the  desired  uniformity. 

In  those  cases  where  the  chemical  formulas  of 
the  original  pharmacopoeia  have  been  found  to 
be  defective  or  objectionable,  their  place  has 
been  supplied  by  more  accurate  and  practicable 
rules,  founded  on  a  course  of  careful  investiga- 
tions. In  this  way  the  economy  and  uniformity 
of  certain  processes  is  greatly  promoted.  New 
preparations,  which  have  been  brought  to  light 
by  the  uncommon  progress  of  pharmaceutic  in- 
vestigations, during  the  last  dozen  years,  are,  in 
various  instances,  inserted.  Such  are  the  prep- 
arations of  iodine,  quinine  and  morphine.  The 
convention,  however,  have  shown  a  wise  forbear- 
ance, in  not  crowding  their  book  with  the  host 
of  new  articles,  often,  we  apprehend,  more  curi- 
ous than  useful,  which  modern  chemistry  has 
been  enabled  to  extort  from  vegetable  drugs. 
Retrenchment  has  been  freely  exercised  in  lop- 
ping off  many  of  the  superfluous  formulas, 
which  a  necessity  for  hasty  compromise  had 


274  ON  THE   PHARMACOPOEIA 

caused  to  be  introduced  into  the  pages  of  the 
old  pharmacopoeia ;  and,  among  other  articles  dis- 
missed is  the  acetum  opii,  or  black  drop,  a  re- 
vived piece  of  antiquity,  wasteful  in  its  com- 
position, and  utterly  uncertain  in  its  strength, 
the  place  of  which  is  now  better  supplied  by  the 
acetated  tincture  of  opium,  and  the  acetate  of 
morphia.  For  ourselves,  by  the  way,  we  lean  to 
the  opinion,  that  opium,  to  produce  its  full 
benefit,  must  be  opium  still,  and  we  are  not  sure 
that  any  of  the  artificial  salts  of  morphia  are 
better  than  the  natural  meconate.  "We  have  seen 
delirium  tremens  brought  on  under  the  use  of 
denarcotized  laudanum.  If  the  crude  drug  were 
cumbersome  from  the  bulk  necessary  to  form  a 
dose,  as  in  the  case  of  cinchona,  it  would  be 
highly  useful  to  reduce  its  active  ingredient  into 
a  smaller  compass.  But  this  is  not  the  case  with 
many  of  the  narcotics. 

Very  complex  medical  formulas,  such  as 
abound  among  the  old  writers,  and  still  encum- 
ber the  pages  of  many  of  the  pharmacopoeias,  we 
deem  to  be  a  superfluous  appendage  to  medical 
science.  One  of  the  greatest  modern  improve- 
ments is  found  in  the  simplification  of  medical 


OF  THE  UNITED  STATES.         275 

prescriptions.  The  art  of  prescribing  appears  to 
us  a  more  simple  affair  than  it  has  been  repre- 
sented by  the  hypercritical  pedantry  of  Dr.  Paris. 
We  admit  that  adjuvants  will  help,  and  that  cor- 
rigents  will  correct;  nevertheless,  we  find  that 
castor-oil,  ipecac,  and  opium,  will  often  do  their 
duty  without  either.  In  admitting  the  influence 
of  chemical  considerations  in  the  exhibition  of 
medicines,  it  is  important  to  recollect  that  the 
stomach  has  a  chemistry  of  its  own,  and  that  the 
digestive  organs  exert  a  material  control  over 
the  force  of  ordinary  chemical  agents,  separating 
elements  which  have  strong  mutual  attractions, 
and  dissolving  bodies  which  are  insoluble  in 
common  menstrua.  We  ought  by  no  means  to 
consider  medicines  inert  in  proportion  as  they 
are  insoluble,  for  we  have  a  proof  to  the  con- 
trary in  calomel.  Nor  are  we  to  consider  those 
substances  medicinally  incompatible,  which,  if 
mixed  out  of  the  body,  occasion  a  precipitate,  or 
a  change  of  color.  What  incompatible,  we  would 
ask,  destroys  the  effect  of  opium,  strychnine,  or 
cantharides  ? 

Another  consideration,  which  has  great  weight 
with  writers  on  chemistry  and  pharmacy,  is  the 


276  ON  THE  PHARMACOPOEIA 

exactness  and  precision  of  the  quantities  em- 
ployed in  their  preparations.  This  circumstance, 
although  of  great  consequence  in  strictly  chemi- 
cal compounds,  is  less  so  in  arbitrary  mixtures  ; 
and  in  the  administration  of  simpler  medicines  its 
importance  diminishes  still  further.  Practical 
physicians  know  that  a  degree  of  accuracy,  ap- 
proaching nearer  than  within  a  fifth  or  sixth  part 
of  the  amount  desired  for  producing  a  given 
effect,  is  seldom  attainable.  Apothecaries  divide 
their  pills  and  powders  by  the  eye,  and  patients 
take  liquids  by  drops  and  spoonfuls.  Nay,  that 
physician  must  possess  uncommon  shrewdness, 
who,  even  after  apportioning  his  dose  by  the 
most  accurate  weight  and  measure,  can  foretell 
with  certainty  how  or  when,  how  much  or  how 
often,  it  is  going  to  operate.  The  stomachs  of 
different  patients,  and  those  of  the  same  patient 
at  different  times,  vary  more,  if  possible,  than  the 
samples  of  the  same  drug  in  commerce. 

On  these  accounts  we  feel  but  little  concern 
for  the  changes  which  the  convention  have 
thought  proper  to  make  in  the  character  or 
strength  of  preparations  and  compositions,  so 
long  as  they  do  not  exceed  the  limits  above  men- 


OF  THE  UNITED  STATES.          277 

tioned.  But  in  a  few  cases  we  observe  that  the 
strength  has  been  altered  in  the  proportion  of 
two  to  one,  or  vice  versa,  and  of  such  changes  we 
propose  to  take  notice.  The  vinum  antimonii, 
which  in  the  old  edition  contained  four  grains  to 
the  fluid  ounce,  in  this  edition  contains  but  two, 
and  is  therefore  reduced  in  strength  one  half. 
We  object  to  this  change,  because  the  stimulat- 
ing character  of  the  menstruum  is  incompatible 
with  the  indications  for  which  antimony  is  gener- 
ally administered,  and  we  apprehend  that  a  glass 
or  two  of  Tenerifle  wine  would  do  no  good  to  a 
man  in  apoplexy  or  incipient  fever.  The  wine, 
indeed,  ought  to  bear  as  small  a  proportion  as 
possible  to  the  operative  medicine,  and  if  the 
London  college  is  followed  in  lessening  the  pro- 
portion of  antimony,  it  should  also  have  been 
followed  in  diluting  the  wine  largely  with  water. 
The  vinegar  and  syrup  of  squill  are  increased  to 
twice  their  former  strength,  —  a  change  in  itself 
of  no  consequence,  when  the  public  shall  have 
learned  to  regulate  the  dose.  Liniment  of  am- 
monia is  reduced  to  one  quarter  of  its  former 
strength.  Can  this  preparation  ever  be  too 
strong  for  the  purposes  to  which  it  is  applied  ? 
24 


278  ON   THE   PHARMACOPOEIA 

In  a  work  so  generally  uniform  and  consen- 
taneous in  its  parts  as  the  American  Pharma- 
copoeia, we  would  willingly  have  dispensed  with 
such  names  as  pulvis  aromaticus  and  pilulre 
catharticas  composite.  These  names  designate 
nothing  that  is  not  common  to  a  thousand  other 
combinations. 

A  few  things  are  omitted  in  this  edition,  which 
we  would  have  willingly  seen  retained ;  but  we 
are  not  disposed  to  'cavil  on  this  account,  since 
in  that  instance,  as  well  as  in  the  case  of 
objectionable  formulas,  the  evil  may  generally 
be  remedied  by  extemporaneous  prescription. 
Every  man  has  his  particular  taste  and  judg- 
ment, and  de  gustibus  non  disputandum.  In  the 
wine  of  antimony,  to  which  we  have  objected, 
the  evil  is  remedied  by  extemporaneous  solu- 
tions in  water,  which  are  far  preferable  to  those 
in  wine.  Even  though  a  pharmacopoeia  should 
arrive  at  the  highest  and  most  unquestioned 
point  of  excellence,  still  physicians  would  suit 
themselves  with  formulas  of  their  own,  adapted 
to  particular  cases.  "We  apprehend  that  most 
practitioners  pass  their  lives  in  ignorance  of 
half  the  contents  of  pharmaceutical  works. 


OF   THE   UNITED   STATES.  279 

For  ourselves,  not  being  particularly  given  to 
hyper-practice,- we  should  feel  a  strong  sentiment 
of  pity  for  the  patients  of  that  physician  whose 
yearly  rounds  involved  the  application  of  the 
whole  pharmacopoeia. 

To  conclude,  —  having  indulged  somewhat 
freely  in  our  remarks  on  the  national  work 
produced  by  the  convention  at  Washington,  — 
we  proceed  to  make  the  amende  honorable,  by 
declaring  our  conviction  that  it  is  on  the  whole 
superior  to  any  of  the  European  pharmacopoeias 
with  which  we  are  acquainted ;  that  it  is  better 
suited  to  the  wants  of  the  American  community 
than  any  work  of  the  kind  which  has  been  pub- 
lished among  us ;  that  it  has  emanated  from  a 
larger  delegation,  and  has  undergone  a  more 
rigorous  supervision,  than  any  similar  produc- 
tion of  the  day  ;  and  that,  therefore,  it  ought 
to  become  the  standard  of  the  United  States. 
In  conformity  with  the  views  expressed  in  the 
first  part  of  this  article,  we  also  hope  that,  to 
relieve  the  profession  from  the  annoyance  of 
incessant  fluctuations,  the  contents  of  this  book 
will  be  respected  by  all  future  conventions  as 
something  solid  and  permanent ;  and  that  if,  as 


280      PHARMACOPOEIA   OF   THE   UNITED   STATES. 

the  edifice  grows  old,  it  shall  be  found  to  need 
repairs,  enlargement,  or  modern  decorations, 
still  that  its  foundations  may  not  be  wantonly 
assailed,  and  that  its  walls  may  stand  as  a  land- 
mark and  a  barrier  against  the  confusion  of 
fluctuating  language. 


ON     THE 


MUCUNA    PBURIENS 


WITH    KEMAEKS    ON 


THE    IRRITABILITY   OF  DIFFERENT 
TEXTURES. 


THE  Dolichos  pruriens  of  Linnaeus,  now  called 
Mucuna  pruriens,  and,  in  English,  Cowhage,  is  a 
climbing-plant  of  the  West  Indies,  the  pods  or 
seed-vessels  of  which  are  covered  with  stiff, 
sharp  bristles,  or  spiculse.  I  have  examined 
these  bristles  in  a  microscope,  and  find  them 
to  be  extremely  acute,  hollow,  and  apparently 
covered  on  the  outside  with  little  warts  or 
vesicles. 

It  is  well  known  that,  when  these  bristles  are 
rubbed  on  the  skin,  they  excite  an  intense  and 
violent  itching,  which  lasts  for  a  considerable 
time.  They  have  been  sometimes  indiscreetly 
used  as  a  counter-irritant,  applied  to  the  skin,  by 
24* 


282  ON   THE   MUCUNA   PRUEIEXS. 

spreading  from  four  to  six  grains  on  lint,  and  con- 
fining it  with  adhesive  plaster.  The  result,  within 
my  observation,  has  been  an  exceedingly  uncom- 
fortable itching  and  burning  of  the  part,  which 
on  the  second  day  became  universally  red  and 
inflamed.  A  copious  eruption  of  papulae  followed, 
Avhich  increased  in  size  for  a  week,  and  at  length 
terminated  in  pustules,  which  required  a  second 
week  to  pass  into  scabs.  In  one  patient  two  or 
three  large  prominences,  like  boils,  continued  for 
ten  days  after  the  rest  of  the  part  was  well. 

The  irritation  produced  by  cowhage  appears 
to  me  greatly  to  exceed  that  which  attends  the 
application  of  flies  or  of  tartar  emetic.  One  pa- 
tient, a  woman,  assured  me  she  got  no  rest  for 
two  nights.  On  examining  the  skin,  it  was  found 
in  a  state  of  great  inflammation,  exquisite  tender- 
ness, and  stuck  full  of  the  spicula?.  After  attempt- 
ing in  vain  to  relieve  the  trouble  by  a  poultice, 
recourse  was  had  to  a  mixture  of  Plaster  of  Paris 
and  water,  which  was  poured  and  suffered  to 
harden  upon  the  skin.  When  withdrawn  from 
the  skin,  it  extracted  and  brought  with  it  the 
spiculas,  to  the  great  relief  of  the  patient.  The 
same  experiment,  however,  proved  inapplicable 


ON   THE  MUCUNA   PEUEIENS.  283 

to  a  man  whose  breast  was  covered  with  hairs, 
and  did  not  admit  of  the  process. 

Cowhage  was  introduced  into  practice,  I  be- 
lieve, by  Dr.  Chamberlain,  who  has  published  a 
small  work  upon  it,  strongly  recommending  it  as 
a  remedy  for  worms.  Reasoning  probably  d  pri- 
ori, he  supposed  that  a  substance,  which  occa- 
sions so  much  irritation  to  the  human  skin,  would 
act  in  a  similar  manner  upon  the  bodies  of  worms 
in  the  alimentary  canal.  Finding  that,  when  mixed 
with  honey  or  molasses,  it  could  be  swallowed 
with  impunity,  this  author,  and  subsequent  wri- 
ters of  Dispensatories,  have  recommended  its  use 
as  a  remedy  for  worms,  in  the  dose  of  from  five 
to  ten  grains.  When  strong  cathartics  have  fol- 
lowed its  employment,  worms  in  some  cases  have 
been  brought  to  light,  but  I  apprehend  not  more 
frequently  than  in  cases  where  no  cowhage  has 
been  given.  Many  years  ago,  having  occasion  to 
doubt  the  anthelmintic  properties  of  this  medi- 
cine, after  it  should  have  undergone  the  process 
of  digestion  in  the  stomach,  I  performed  with  it 
a  number  of  experiments.  A  parcel  of  the  spic- 
ulse  of  full  strength  were  soaked  in  blood-warm 
water  for  about  ten  minutes.  On  withdrawing 


284  ON  THE  MUCUNA  PRUBIEXS. 

them,  they  were  found  softened,  apparently  de- 
prived of  their  venom,  and  wholly  incapable  of 
irritating  the  skin  when  rubbed  upon  it.  Another 
portion  was  tied  up  in  a  muslin  bag,  and  forced 
into  the  stomach  of  a  cat.  At  the.  end  of  ten  min- 
utes an  emetic  was  administered,  which  brought 
up  the  bag  with  the  spiculae  so  far  digested  that 
they  could  not  be  made  to  give  the  slightest  irri- 
tation to  the  skin.  I  am  therefore  obliged  to  con- 
clude that  the  vermifuge  action  attributed  to 
cowhage  was  in  reality  due  to  the  cathartics 
which  followed  its  use. 

Within  a  few  weeks  past,*  I  have  noticed  an- 
other curious  property  of  the  dolichos,  that  it 
stimulates  the  skin,  but  does  not  stimulate  the 
mucous  membrane.  Applied  to  the  hand,  for 
example,  it  immediately  causes  violent  itching  ; 
but  if  rubbed  on  the  inside  of  the  lip,  or  tongue, 
it  excites  no  sensation  beyond  the  ordinary  me- 
chanical stimulus.  In  like  manner  the  effect  on 
the  outside  and  inside  of  the  cheek  are  wholly 
different.  It  is  this  fact,  probably,  and  not  the 
sheathing  quality  of  the  mucilage  or  syrup  in 

*  January,  1844. 


ON  THE   MUCUNA   PEURIENS.  285 

which  it  is  taken,  that  enables  patients  at  all  times 
to  swallow  it  with  impunity,  as  a  medicine. 

It  is  a  field  of  interesting  inquiry  to  ascertain 
how  far  particular  morbid  poisons  and  stimulants 
confine  their  action  to  particular  textures.  As  far 
as  my  observation  extends,  the  cutaneous  poisons 
which  produce  eruptions  on  the  skin,  independent 
of  any  acrimony,  or  general  stimulating  quality, 
such  as  the  Rhus  vernix,  <fec.,  for  the  most  part 
confine  their  action  to  the  true  skin  or  dermoid 
texture,  and  do  not  inflame  the  mucous  mem- 
brane, so  that  they  have  often  been  eaten  with 
impunity.  Were  it  otherwise,  effects  highly  dan- 
gerous to  life  would  occur  from  the  inflammation 
of  the  trachea  and  other  mucous  passages,  if  an 
action  should  take  place  in  them  at  all  corre- 
spondent in  violence  to  that  which  is  seen  upon 
the  skin.  But  there  is  another  class  of  poisons 
which  affects  the  mucous  membrane,  without  in- 
commoding the  skin,  at  least  by  superficial  con- 
tact. Such  is  the  effluvium  of  roses  and  that  of 
new  hay,  which  always  affect  certain  persons 
with  catarrhal  symptoms.  Such  is  also  the  poison 
of  syphilis  and  that  of  gonorrhoea,  which  are  be- 
lieved not  to  act  through  the  cuticle,  but  which 


286  ON  THE  MUCUNA  PRCRIENS. 

develop  their  activity  as  soon  as  they  are  brought 
in  contact  with  a  mucous  surface. 

There  are  other  poisons,  which  seem  alike  to 
influence  the  dermoid  and  mucous  tissues.  The 
sting  of  a  bee  or  wasp  immediately  inflames  the 
skin,  and  it  is  said  to  have  occasioned  death  by 
suffocation  when  applied  to  the  fauces  or  throat. 
It  is  possible  that  the  morbid  poison  of  scarlatina, 
and  of  some  other  diseases  which  affect  simulta- 
neously the  skin  and  mucous  membrane,  may 
possess  the  same  universality  of  action. 


0  N    T  H  E 

POISONOUS    EFFECTS 


AMERICAN  PARTRIDGE,  OR  RUFFED 
GROUSE. 


THE  Tetrao  umbelhis  of  Linnaeus,  variously 
called  Partridge  in  the  Northern  and  Eastern 
States,  Pheasant  in  Pennsylvania  and  the  West- 
ern States,  and  "  Ruffed  Grous "  by  Wilson, 
Nuttall,  and  Audubon,  appears  to  inhabit  the 
continent  from  Hudson's  Bay  to  the  Gulf  of 
Mexico,  and  from  the  Atlantic  to  the  Mississippi. 
It  is  a  handsome  bird,  of  the  Gallinaceous  tribe, 
with  mottled  plumage,  the  tail  eighteen-feathered, 
speckled,  and  barred  with  black,  and  with  a  black 
subterminal  band.  The  male  has  a  ruff  of  broad 
black  feathers  on  the  sides  of  the  neck,  the  female 
a  smaller  ruff,  of  a  dusky  brown.  Its  favorite  re- 


288       ON  THE  POISONOUS  EFFECTS  OF 

sorts  are  mountainous  regions  covered  with  ever- 
green trees,  and  in  more  cultivated  countries  it 
often  frequents  apple-trees,  which  are  secluded 
or  concealed  by  woods,  having  a  fondness  for  the 
buds  of  this  tree.  It  is  well  known,  to  residents 
in  the  interior,  by  the  drumming  noise  which  in 
the  pairing  season  it  makes  with  its  wings,  and 
also  by  the  stratagem  with  which  the  mother 
protects  her  young  by  an  illusive  demonstration 
of  surrendering  herself  in  their  place. 

The  partridge  is  quite  common  in  the  Eastern 
States,  and  constitutes  one  of  the  most  frequent 
kinds  of  game  in  our  markets.  The  flesh  is  much 
prized  for  the  delicacy  of  its  flavor,  and  is  in  its 
greatest  perfection  in  September  and  October. 
It  feeds  in  summer  on  wild  berries,  and  at  other 
seasons  on  the  leaves,  buds  and  seeds  of  various 
plants. 

It  is  generally  known,  that  although  vast  num- 
bers of  these  birds  are  every  year  consumed  with 
impunity,  yet  instances  now  and  then  happen  of 
persons  being  apparently  poisoned,  or  made  sick 
with  alarming  symptoms,  soon  after  swallowing 
their  flesh.  The  following  cases  are  selects  1 
from  among  a  larger  number,  which  have  IHM/II 


THE  AMERICAN  PARTRIDGE.  289 

observed  by  myself  or  my  medical  friends,  and 
of  which  a  part  are  in  the  records  of  the  Society 
of  Medical  Improvement. 

CASE  I.  —  A  gentleman  of  this  city  having 
dined  at  Worcester  in  part  upon  partridge,  took 
the  cars  for  Boston  half  an  hour  afterward.  In 
an  hour  after  entering,  he  was  taken  with  sensa- 
tions like  those  of  sea-sickness,  accompanied 
with  dizziness  and  great  prostration  of  strength. 
With  difficulty  he  got  his  head  out  and  vomited 
from  the  window  of  the  car.  He  continued  faint, 
cold,  dizzy,  and  unable  to  sit  up,  with  ringing  in 
the  ears  and  imperfect  vision.  He  was  conveyed 
to  his  house  in  a  sinking  and  nearly  insensible 
state.  When  I  first  saw  him,  he  was  cold  and 
moist,  with  a  slow,  intermittent  and. very  feeble 
pulse,  difficult  comprehension,  and  sluggish  utter- 
ance. He  had  vomited  again,  with  some  relief. 
His  vision  was  partially  recovered.  Stimulants 
had  been  given  him,  with  hot  applications  and 
frictions  to  the  surface,  under  which  he  gradually 
recovered. 

CASE  II.  —  A  lady  of  delicate  health  took  at 
25 


290  ON   THE  POISONOUS   EFFECTS   OF 

dinner  a  small  piece  of  the  breast  and  leg  of  a 
partridge.  Two  hours  afterwards  she  became 
suddenly  very  faint,  and  her  physician  (Dr.  Put- 
nam) was  called.  She  was  found  by  him  in  a  sit- 
ting posture  on  the  bed,  supported  by  two  assist- 
ants, with  the  body  bent  forward.  The  surface 
was  generally  cold,  countenance  pale  and  sunken, 
and  voice  feeble.  There  was  slight,  frequent 
convulsive  action  of  the  muscles.  The  pupils 
were  dilated,  with  loss  of  vision.  Pulse  irregu- 
lar, feeble,  at  times  nearly  imperceptible.  There 
was  drowsiness  approaching  to  insensibility, 
nausea  and  vomiting.  Spirituous  stimulants 
were  given  and  ipecacuanha,  with  warmth,  fric- 
tion and  sinapisms  externally.  Soon  after  free 
vomiting  took  place  there  was  evident  amend- 
ment. The  sensibility  returned,  questions  were 
comprehended,  but  the  answers  were  slow  and 
laborious.  In  the  course  of  two  or  three  hours 
vision  was  restored  with  contraction  of  the 
pupils  and  intolerance  of  light,  with  a  remain- 
ing sense  of  numbness  and  uneasiness  in  the 
head. 

CASE  III.  —  A  man  aged  sixty,  who  had  always 


THE   AMEEICAN  PARTRIDGE.  291 

been  healthy,  but  within  a  few  months  troubled 
with  shortness  of  breath,  which  his  physician 
attributed  to  some  affection  of  the  heart,  ate  the 
white  meat  of  a  partridge,  avoiding  the  dark 
meat  and  the  parts  contiguous  to  it.  About  an 
hour  afterwards  he  went  to  church,  where  he  was 
shortly  taken  with  a  sensation  of  distress  at  the 
stomach,  which  he  referred  to  the  disagreement 
of  his  food.  He  endeavored  to  resist  this  annoy- 
ance, and  kept  his  seat  for  some  time,  but  at 
length  his  sight  totally  left  him,  he  became  faint, 
and  fell.  He  was  carried  out  of  church,  and  laid 
on  his  back  in  the  open  air.  At  this  time  there 
was  no  pulse,  and  the  respiration  was  hardly  per- 
ceptible. These  symptoms  were  at  first  at- 
tributed by  those  around  to  the  suspected  disease 
of  the  heart,  but  in  the  course  of  ten  minutes  he 
began  to  revive.  The  first  word  he  uttered  was 
"  poisoned,"  and  the  second,  "  the  partridge." 
He  soon  began  to  revive,  sat  up,  got  upon  his 
feet  with  assistance,  but  had  lost  all  power  over 
his  legs,  and  was  unable  to  stand.  He  was  now 
put  into  a  carriage,  some  pressure  was  made 
upon  the  stomach,  and  he  began  to  vomit. 
Ipecac,  and  warm  water  were  given  him  until  the 


292  ON  THE  POISONOUS  EFFECTS  OF 

stomach  was  fully  evacuated.  He  remained 
somewhat  delirious  for  a  few  hours,  but  on  the 
following  day  was  restored  to  his  customary 
health. 

CASE  IV. — A  gentleman,  twenty-six  years  of 
age,  dined  at  five  P.M.  on  soup,  boiled  tongue  and 
potatoes,  and  ate  the  leg  and  part  of  the  breast 
of  a  partridge.  He  afterwards  went  to  a  club- 
room,  and  remained  till  eight.  On  going  out  at 
this  time  he  became  chilly,  and  felt  a  sharp  pain 
through  the  temples.  He  repaired  to  a  shop  for 
some  soda-water,  and,  while  standing  there,  was 
affected  with  vertigo  and  a  "  trance-like  "  feeling. 
This  was  followed  by  ringing  in  the  ears,  and  a 
remarkable  sense  of  coldness,  mostly  in  the  back 
of  the  neck  and  shoulders.  He  was  unable  to 
get  warm  at  the  fire,  and  the  sensation  given  to 
bystanders  by  his  head  was  compared  to  that  of 
the  contact  of  a  stone  jar.  He  had  taken  hot 
spirit  and  water,  and  was  sitting  up  when  seen 
by  Dr.  Holmes  at  nine  o'clock.  At  this  time  the 
voice  and  expression  were  natural,  mind  a  little 
excited,  vision  dim  at  times  and  once  or  twice 
quite  lost,  pupils  widely  dilated  and  equal,  con- 


THE   AMERICAN   PARTRIDGE.  293 

trading  but  slightly  on  the  approach  of  a  light, 
hands  rather  cold,  pulse  76,  regular,  small  but 
not  thready,  no  nausea  nor  vomiting.  Took 
wine  of  ipecac.,  and  threw  off  freely  portions  of 
food.  In  the  course  of  half  an  hour  was 
thoroughly  relieved,  but  was  languid  and  cos- 
tive next  day. 

Two  or  three  other  persons,  as  it  appeared, 
had  partaken  of  the  same  partridge  without  obvi- 
ous inconvenience. 

CASE  Y.  —  A  gentleman,  aged  seventy-four,  of 
full  habit  and  subject  to  gout,  ate  at  breakfast 
the  black  meat  of  one  partridge.  In  an  hour  or 
two  he  went  to  church,  where  he  soon  became 
sick,  faint  and  dizzy.  On  being  carried  home  he 
was  found  in  a  state  approaching  that  of  col- 
lapse, pale,  livid,  cold,  nearly  pulseless,  and  with- 
out vision.  His  appearance  was  that  of  a  dying 
man,  with  glazed  eyes  and  gasping  for  breath. 
Had  repeated  nausea,  but  vomited  fluids  only. 
Took  stimulants,  principally  hot  gin  and  water, 
and  gradually  recovered,  after  passing  a  restless 
night  with  much  thirst.  It  was  remarked  that 
others  of  the  family  ate  the  white  meat  of  the 
25* 


294      ON  THE  POISONOUS  EFFECTS  OF 

same    bird    without     any    disagreeable     conse- 
quences. 

CASE  VI.  —  A  female,  who  had  eaten  at  twelve 
o'clock  of  the  white  and  black  meat  of  a  par- 
tridge, in  half  an  hour  was  taken  with  pain  in  the 
chest  and  throat,  nausea,  weakness  and  loss  of 
sight.  "Was  seen  by  her  physician  at  four  P.  M. 
Her  pulse  was  54,  and  hardly  perceptible.  After 
taking  brandy  and  water  and  half  a  drachm  of 
ipecac.,  her  pulse  improved  in  strength,  but  was 
still  only  54.  Her  mind  remained  clear,  and  the 
most  remarkable  symptoms  were  the  blindness 
and  slow  and  feeble  pulse. 

CASE  VII.  —  An  elderly  gentleman,  of  full 
habit,  breakfasted  in  part  on  a  partridge.  In  two 
hours  he  was  seized  with  a  dizziness,  partial  loss 
of  consciousness,  and  violent  pain  extending 
through  the  abdomen  to  the  back.  When  visited 
by  Dr.  H.  J.  Bigelow,  he  was  found  on  his  hands 
and  knees,  cold,  faint,  partly  insensible  and 
nearly  pulseless.  The  pain  having  subsided,  re- 
turned at  intervals,  causing  him  to  call  often  to 
have  his  back  rubbed.  After  an  emetic  he  was 


THE   AMERICAN   PARTRIDGE.  295 

much  relieved,  and  rallied  slowly  in  the  course 
of  the  afternoon. 

CASE  VIII.  —  For  this  and  the  two  following, 
I  am  indebted  to  Dr.  Morrill  Wyman. 

A  very  athletic  and  active  man,  aged  fifty,  at 
times  making  very  great  and  long-continued  ex- 
ertion and  eating  freely,  February  14,  1849,  took 
supper  at  seven,  P.  M. ;  ate  two  roasted  partridges, 
with  ale  and  other  liquors.  At  eight  o'clock  felt 
somewhat  heavy,  and,  thinking  he  had  eaten 
too  much  supper,  proposed  to  go  to  the  bowling- 
alley  for  exercise.  In  a  few  minutes  perceived 
that  the  lights  in  the  room  had  a  blue  tinge,  —  the 
fire  also  ;  asked  if  any  new  kind  of  burning-fluid 
had  been  used,  and  immediately  fell,  with  loss  of 
consciousness.  Just  previously  to  the  loss  of 
consciousness,  had  pain  in  the  back  of  the  neck, 
extending  down  along  the  spine  and  into  the 
arm.  In  ten  or  fifteen  minutes  partially  re- 
covered,—  then  again  unconscious;  muscles  of 
limbs  completely  relaxed  ;  face  very  pale  ;  respi- 
ration four  to  six  times  per  minute  ;  pulse  18  to 
22  ;  hands  and  feet  cold  and  moist ;  groaned  fre- 
quently ;  vomited  freely  and  spontaneously,  and 


296  ON   THE   POISONOUS  EFFECTS   OF 

afterwards  under  the  influence  of  mustard-flour 
mixed  with  warm  water.  "Warm  blankets  and 
bottles  of  hot  water  were  applied  to  the  epigas- 
trium and  limbs,  and  in  the  course  of  two  hours 
he  had  recovered  his  consciousness  and  drank 
warm  tea.  Slept  well  during  the  night.  In  the 
morning  was  quite  well. 

CASE  IX.  —  Same  individual.  February  23, 
1850,  went  into  the  country  in  the  morning  and 
rode  till  three  o'clock,  P.  M. ;  then  sat  down  in  the 
open  air  and  ate  a  part  of  a  partridge,  but  it  was 
so  bitter  that  the  remainder  was  thrown  away  ; 
drank  a  wine-glass  of  brandy.  Took  railroad 
train,  and  on  leaving  it  in  thirty-five  minutes 
walked  from  fifteen  to  twenty  minutes,  when 
(about  one  hour  after  eating  the  partridge)  had 
pain  in  the  back  of  the  neck  and  limbs.  Passed 
a  house,  and  observed  that  the  lights  appeared 
blue,  and  immediately  suspected  the  partridge  of 
being  the  cause  of  his  trouble.  Soon  after,  found 
himself  at  the  bottom  of  a  steep  declivity,  hav- 
ing lost  his  consciousness  and  rolled  down  a 
bank.  Got  up,  and  walked  to  a  house  ;  again 
noticed  the  blue  lights.  In  attempting  to  take  a 


THE  AMERICAN   PARTRIDGE.  297 

glass  of  cold  water  again  lost  his  consciousness 
and  fell ;  was  carried  home,  and,  after  taking 
mustard-flour,  vomited,  and  was  soon  relieved. 
Before  vomiting,  respiration  very  slow,  and  not 
more  than  half  the  usual  number  of  inspirations ; 
pulse  42  per  minute ;  hands  and  feet  cold  and 
the  face  pale.  During  the  periods  of  loss  of  con- 
sciousness, which  did  not  continue  more  than  five 
minutes  at  a  time,  the  limbs  were  quite  power- 
less. The  recovery  was  sudden,  and  the  action 
energetic ;  speech  impeded,  apparently  from  want 
of  muscular  power.  Time  elapsed  between  first 
symptoms  and  relief  by  vomiting,  from  an  hour 
and  a  half  to  two  hours. 

CASE  X.  —  Mrs.  W.,  aged  forty-five,  ate  for 
dinner,  two  days  before  the  date  of  the  last  case, 
a  part  of  a  roasted  partridge,  bought  at  the  same 
time  with  that  used  by  her  husband.  This,  also, 
was  extremely  bitter,  and  only  a  small  quantity 
eaten.  After  dinner  walked  a  mile  to  a  con- 
servatory ;  when  near  the  conservatory  felt  weak; 
pain  in  both  back  of  neck  and  limbs.  Felt  faint 
in  the  conservatory,  and  obliged  to  return  to  the 
open  air ;  was  nauseated,  but  did  not  vomit. 


298  ON   THE  POISONOUS  EFFECTS   OF 

Immediately  walked  towards  home  ;  found  her 
limbs  unsteady,  obliged  to  run,  and  then  stop  and 
support  herself  by  the  fence  ;  was  compelled  to 
lie  down,  but  did  not  lose  consciousness ;  was 
carried  home.  The  pain  in  the  back  of  the  neck 
and  limbs  continued  till  nine  o'clock,  when  she 
went  to  bed.  Had  occasionally  some  difficulty 
of  breathing,  a  catching  of  the  breath.  In  the 
morning  was  quite  well. 

Neither  of  these  individuals  have  eaten  par- 
tridges since. 

The  principal  and  most  characteristic  symp- 
toms were  loss  of  consciousness ;  relaxation  of 
the  muscles,  and  in  one  instance  of  the  sphinc- 
ters ;  paleness  ;  cold  feet  and  hands ;  slow  and 
infrequent  respiration,  and  slow  and  infrequent 
but  regular  pulse.  The  act  of  vomiting  was  fol- 
lowed by  almost  immediate  relief. 

To  these  cases  may  be  added  a  number  more, 
the  outlines  of  which  have  been  communicated 
by  different  medical-  friends. 

From  a  general  analysis  of  the  symptoms  pro- 
duced, it  appears  that  under  certain  circum- 
stances the  flesh  of  the  partridge  acts  as  a  direct 


THE  AMEEICAN  PARTRIDGE.        299 

sedative  poison,  impairing  the  functions  of  the 
brain,  and,  in  connection,  those  of  the  digestive 
and  circulating  systems.  The  cerebral  symp- 
toms, in  a  majority  of  cases,  have  been  vertigo, 
loss  of  sight,  tinitus  aurium,  and  in  bad  cases 
general  loss  of  the  power  of  sensation  and  volun- 
tary motion.  Respiration  has  been  slow,  some- 
times to  a  great  degree.  In  the  circulating  sys- 
tem there  has  been  syncope,  feeble  and  some- 
times irregular  action  of  the  heart ;  weak,  slow, 
and  sometimes  imperceptible  pulse ;  cold  surface, 
and  pale  or  livid  complexion.  In  the  digestive 
system  there  is  oppression,  nausea  with  ten- 
dency to  vomit,  and  in  many  cases  pain  in  the 
abdomen  extending  through  to  the  back.  In 
more  rare  cases  pain  has  been  felt  in  the  head 
and  limbs. 

The  foregoing  morbid  symptoms  have  mostly 
appeared  within  two  or  three  hours  after  taking 
the  food.  But  instances  have  occurred  in  which 
persons  have  been  taken  before  leaving  the 
table. 

The  poison  of  the  partridge  has  never,  to  my 
knowledge,  proved  fatal.  The  remedies  usually 
and  properly  resorted  to,  are  a  prompt  emetic, 


300      ON  THE  POISONOUS  EFFECTS  OF 

accompanied  or  followed  by  stimulants,  if  the 
prostration  is  urgent.  Free  spontaneous  vom- 
iting not  unfrequently  removes  the  difficulty 
before  the  physician  arrives.  Acrid  stimulants, 
such  as  a  teaspoonful  of  mustard,  may  serve  the 
double  purpose  of  a  quick  emetic  and  an  incitant 
to  the  depressed  vital  powers.  Spirits,  and  other 
diffusible  stimulants,  are  indicated  by  the  sink- 
ing condition  of  the  patient ;  but  the  anxiety  of 
friends  often  leads  to  their  excessive  administra- 
tion, for  which  the  patient  pays  by  a  prolonged 
continuance  of  his  narcotism.  Friction  and  ex- 
ternal warmth  are  indicated  and  generally  desired 
by  the  patient. 

The  flesh  of  the  partridge  is  justly  esteemed 
as  a  great  delicacy,  and  is  abundantly  sold  in  the 
markets  of  this  and  many  other  cities.  Audu- 
bon  says  of  it :  "  In  my  humble  opinion  it  far 
surpasses  as  an  article  of  food  any  land  bird  we 
have  in  the  United  States,  except  the  wild  tur- 
key." It  is  in  its  best  condition  in  the  fall  of  the 
year,  and  continues  to  be  common  throughout 
the  winter.  We  have  hardly  any  species  of  game 
which  is  sought  for  with  more  avidity,  or  con- 


THE  AMERICAN   PARTRIDGE.  301 

sumed,  in  proportion  to  its  size,  in  greater  num- 
bers. As  a  general  rule  it  is  and  may  be  taken 
with  perfect  impunity. 

The  fact  that  the  meat  of  the  partridge  occa- 
sionally proves  poisonous  has  given  rise  to 
much  speculation  in  regard  to  the  cause.  The 
point  most  generally  admitted  respecting  it;  is, 
that  its  bad  eifects  chiefly,  if  not  always,  take 
place  in  winter,  when  the  ground  is  covered 
with  snow.  This  circumstance  has  given  rise 
to  a  popular  belief  that  the  noxious  quality  in 
the  meat  of  the  bird  is  attributable  to  some  poi- 
sonous food  on  which,  in  winter,  it  is  driven  to 
subsist.  And  a  prevalent  suspicion  has  been 
fixed  upon  the  mountain  laurel  (Kalmia  latifo- 
lia),  on  the  buds  and  leaves  of  which  the  par- 
tridge has  been  supposed  to  feed  in  cold  weath- 
er. But  this  suspicion  appears  to  be  not  well 
founded,  since  I  have  observed,  in  experiments 
made  purposely,  that  the  leaves  of  the  kalmia  are 
not  particularly  poisonous  when  taken  into  the 
human  stomach  in  any  quantity  which  the  bird 
would  be  likely  to  devour ;  and  the  crops,  when 
examined  in  winter,  are  found  to  contain  leaves 
and  fragments  of  most  of  the  wild  evevgreen 
26 


302  ON  THE  POISONOUS  EFFECTS   OF 

plants  which  are  in  verdure  at  that  time.  I  have 
found,  among  other  things,  portions  of  leaves  of 
Pyrola,  Gaultheria,  Smilax,  Coptis,  Mitchella,  — 
also  buds  of  Azalea,  alder  and  apple  tree,  which 
latter  appears  to  be  a  favorite  food  with  the 
partridge. 

It  is,  furthermore,  not  very  probable  that  the 
common  process  of  putrid  decomposition  is  con- 
cerned in  producing  the  noxious  effects  in  ques- 
tion, for  this  circumstance  would  be  generally 
detected  by  the  taste,  and  the  incipient  putres- 
cence so  often  recognized  in  game  is  usually 
corrected  by  the  antiseptic  effect  of  the  gastric 
juice. 

More  probable  solutions  of  the  difficulty  are, 
1.  That  the  bird  is  affected  with  some  disease  at 
the  time  of  its  death.  2.  That  some  slow  chem- 
ical change,  not  putrefactive,  may  take  place 
when  the  flesh  is  long  kept  in  cold  weather, 
as  observed  by  my  friend  Dr.  Cabot.  3.  That 
the  idiosyncrasy  of  individuals  renders  some  per- 
sons intolerant  of  this  species  of  food.  This  lat- 
ter supposition  is  sustained  by  the  facts,  that  the 
same  person  has  sometimes  been  affected  twice, 
—  that  a  majority  of  persons,  partaking  of  the 


THE   AMEEICAN  PAETKIDGE.  303 

same  partridge,  escape  unharmed,  when  others 
are  poisoned,  —  and  that  individuals  are  found 
who  cannot  eat  lobster,  mackerel,  and  certain 
other  kinds  of  food,  without  suffering  symp- 
toms approaching  in  character  to  those  already 
described. 


ON 

COFFEE    AND    TEA; 

AND   THEIR 

MEDICINAL  EFFECTS. 


THE  articles  Coffee  and  Tea  have  been  so  long 
and  so  generally  introduced  as  luxuries  of  the 
table,  that  they  are  now  viewed  by  the  world  as 
materials  of  diet  and  nutrition,  and  not  in  their 
proper  light,  as  substances  incapable  of  nourish- 
ing the  body  in  any  considerable  degree,  and 
depending  for  their  value  on  an  effect  which  is 
simply  medicinal.  If  any  one  doubts  whether 
they  should  be  referred  to  the  class  of  aliments, 
or  to  that  of  medicines,  let  him  try  the  experi- 
ment of  supporting  life  upon  coffee  or  tea  alone, 
and  he  would  probably  find  that  his  term  would 
not  be  much  prolonged  by  such  an  expedient. 
Yet,  when  taken  in  combination  with  nutritious 
food,  both  these  articles  exert  a  salutary  and 


ON  COFFEE  AND   TEA.  305 

useful  influence  upon  digestion  and  health.  The 
experience  of  all  civilized  nations  has  shown 
them  to  be  innocent,  when  used  at  proper  times 
and  in  moderate  quantities,  while,  like  all  other 
medicinal  substances,  they  are  capable  of  abuse, 
if  taken  under  improper  circumstances  or  to  an 
excessive  degree. 

As  these  two  substances  have  a  close  affinity 
to  each  other,  possessing  properties  not  known 
to  exist  in  any  other  plant,  they  are  properly 
^associated  with  each  other  as  a  class  under  the 
name  of  anthypnotics.  Should  any  plant  be  here- 
after found  to  possess  qualities  similar  to  those 
of  coffee  and  tea,  it  would  doubtless  acquire  an 
immediate  value,  and  perhaps  be  in  the  same 
request  as  these  imported  articles.  The  subject 
is  an  interesting  one  for  future  inquiry,  and 
already  an  identity  in  the  active  alkaloid  prin- 
ciple has  been  asserted  for  some  species  of  Ilex 
and  Paullinia,  consumed  by  the  inhabitants  of 
South  America. 

The  prevailing  fondness  for  coffee  and  tea  is 

probably  an  acquired  taste,  like  that  for  tobacco 

and  alcohol.     The  flavor -of  both  these  articles  in 

their  crude  state  is  disagreeable  to  most  persons 

26* 


306  ON   COFFEE   AND   TEA. 

not  already  initiated  in  their  use.  But  the  dis- 
covery in  modern  times  of  their  secondary  ef- 
fects, and  the  agreeable  influence  which  they 
exert  on  the  brain  and  nervous  system,  has  cre- 
ated for  them  a  general  demand  and  consumption 
throughout  the  world. 

COFFEE. 

Coffee  is  the  product  of  the  Coffcea  Arabica,  a 
small  tree  which  grows  native  in  Arabia  and  sev- 
eral warm  countries  of  the  old  continent,  and  is 
now  cultivated  extensively  in  the  West  Indies 
and  tropical  parts  of  the  continent  of  America. 
The  fruit  of  this  tree  is  a  roundish  oblong  berry, 
containing  two  seeds,  the  form  and  appearance 
of  which  are  sufficiently  familiar,  constituting 
the  common  coffee  which  is  brought  to  this 
country. 

The  use  of  coffee  was  unknown  to  the  Greeks 
and  Romans,  and  does  not  appear  to  have  been 
known  in  the  Asiatic  countries  as  late  as  the 
time, of  the  Crusades  in  the  thirteenth  century, 
although  its  first  introduction  into  Europe  was 
from  Arabia.  It  seems  to  have  been  earliest  in 
use  in  Ethiopia,  where  it  has  been  drunk  by  the 


ON   COFFEE   AND   TEA.  307 

natives  for  a  great  length  of  time.  Mr.  Bruce, 
in  his  Travels  in  Abyssinia,  states  that  the  Gallas, 
a  wandering  nation  of  Africa,  in  their  incursions 
on  Abyssinia,  being  obliged  to  traverse  immense 
deserts,  and  wishing  to  be  encumbered  with  as 
little  baggage  as  possible,  take  with  them  a  mix- 
ture of  coffee  and  butter  rolled  up  into  balls,  and 
carried  in  a  leathern  bag.  One  of  these,  about 
the  size  of  a  billiard  ball,  keeps  them,  they  say, 
in  strength  and  spirits  during  a  day's  fatigue. 
Coffee  was  introduced  into  Mecca,  Medina  and 
Cairo,  about  the  middle  of  the  fifteenth  century, 
and  two  coffee-houses  were  opened  at  Constanti- 
nople in  1554.  Both  at  Cairo  and  in  Turkey  it 
had  to  encounter  political  and  religious  opposi- 
tion. The  dervises  affirmed  that  roasted  coffee 
was  nothing  but  a  coal,  and  that  the  eating  of 
coals  was  forbidden  by  the  laws  of  their  prophet. 
So  that  the  coffee-houses  were  obliged  to  be  shut 
up  until  "  a  more  sensible  mufti "  succeeded  in 
convincing  the  people  that  roasted  coffee  was 
not  a  coal ;  upon  which  they  were  again  opened. 
In  later  years  the  use  of  coffee  became  extremely 
prevalent  throughout  the  East.  Houses  for  sell- 
ing it  were  established  in  all  parts  of  the  Turkish 


308  ON   COFFEE   AND   TEA. 

empire ;  it  was  introduced  into  private  families, 
and  the  refusal  of  a  husband  to  supply  his  wife 
with  coffee  was  reckoned  among  the  legal  causes 
of  a  divorce. 

In  Europe  coffee  was  introduced  into  France 
and  England  about  a  century  and  a  half  ago.  So 
rapid  was  the  progress  of  a  taste  for  it,  after  it 
became  known,  that,  in  eight  years  from  its  intro- 
duction, it  had  become  in  England  a  subject  of 
public  revenue. 

Coffee  has  seldom  been  used  in  its  raw  state, 
except  sometimes  as  a  fanciful  addition  to  certain 
liqueurs  and  ices.  A  decoction  of  raw  coffee  is 
disagreeable  to  the  taste,  but  appears  to  possess 
properties  analogous  to  those  which  it  exhibits 
after  being  roasted.  The  roasting  of  coffee  im- 
proves its  flavor,  and  occasions  considerable 
changes  in  its  chemical  constitution,  without 
impairing  its  stimulant  or  medicinal  activity.  A 
peculiar  alkaloid,  called  caffeine,  is  detected  in 
both  raw  and  roasted  coffee.  It  is  considered 
by  chemists  to  be  identical  with  theine,  found  in 
tea  and  in  a  few  other  vegetables.  An  aromatic 
oil,  which  has  been  called  caffeone,  is  produced 
during  the  process  of  roasting. 


ON   COFFEE   AND   TEA.  309 

During  the  extensive  trial  which  has  been 
made  all  over  the  world,  as  to  the  effect  of  cof- 
fee upon  the  health,  no  small  diversity  of  opinion 
has  existed  in  regard  to  its  specific  powers.  Of 
the  properties  ascribed  to  it,  two  seem  better 
established  than  any  others.  These  are  its  prop- 
erty of  assisting  digestion,  and  that  of  obviating 
drowsiness.  Coffee,  when  taken  into  the  stom- 
ach, usually  creates  a  pleasing  sense  of  vigor  in 
that  organ ;  it  moderates  alimentary  fermentation, 
takes  off  the  feeling  of  distention  and  heaviness 
occasioned  by  over-eating,  counteracts  in  some 
degree  the  fumes  of  wine,  and  produces  a  light- 
ness and  hilarity  of  mind,  more  moderate  but 
more  permanent  than  that  occasioned  by  vinous 
or  spirituous  liquors.  The  custom,  derived  from 
the  French,  of  drinking  coffee  after  dinner,  is 
beneficial,  and  powerfully  promotes  the  process 
of  digestion.  It  is v  known  to  epicures  of  most 
countries  that  a  cup  of  strong  coffee,  at  the  end 
of  some  hours  spent  at  the  table,  enables  them 
to  continue  their  functions,  both  of  body  and 
mind,  to  a  greater  extent  than  would  have  been 
done  under  any  other  assistance* 

It  is  well  known  that  coffee  is  strongly  pro- 


310  ON   COFFEE   AM)   TEA. 

motive  of  watchfulness,  and  enables  us  to  resist 
for  a  long  time  the  approaches  of  sleep.  Stu- 
dents, whose  lucubrations  occupy  a  considerable 
portion  of  the  night,  find  a  great  increase  of  the 
vigilance  and  vigor  of  their  faculties,  derived 
from  the  use  of  both  coffee  and  tea.  In  fact,  the 
long  habit  of  drinking  these  articles  renders  us 
so  dependent  on  them  for  the  power  of  keeping 
the  mind  awake  and  active,  that  a  change  from 
them  to  any  other  kind  of  diet  creates  in  most 
persons,  at  least  for  a  tune,  a  drowsiness  and 
dulness  of  intellect.  Hence  it  is  common  to 
hear  milk  and  chocolate  accused  of  creating 
sleepiness,  —  an  effect  which  arises,  not  from  any 
real  soporific  influence  in  those  articles,  but  from 
the  change  of  diet,  and  the  want  of  the  custom- 
ary stimulus  of  coffee  and  tea.  The  Turks  and 
Arabians  consume  large  quantities  of  coffee, 
because  it  acts  as  an  antidote  to  the  stupefying 
effect  of  opium,  to  the  abuse  of  which  those 
nations  are  generally  addicted.  It  has  already 
been  mentioned,  and  is  a  fact  which  every  prac- 
titioner should  remember,  that  perhaps  no  anti- 
dotal substance  exerts  so  powerful  an  agency  in 
counteracting  the  effect  not  only  of  opium,  but 


ON   COFFEE  AND   TEA.  311 

of  alcohol  and  the  whole  tribe  of  narcotics,  as  a 
seasonable  draught  of  strong  coffee. 

Many  complaints  have  been  ascribed  to  the 
frequent  and  excessive  use  of  coffee,  such  us 
tremors,  headache,  vertigo,  and  some  more  seri- 
ous disorders.  These  complaints  are  most  apt 
to  appear  when  coffee  has  been  taken  alone, 
without  a  sufficient  quantity  of  nourishment  ac- 
companying it.  It  is  common  for  physicians,  in 
the  course  of  practice,  to  hear  complaints  of  a 
sinking  at  the  stomach,  universal  trembling  of 
the  limbs,  and  a  loss  of  muscular  power,  coming 
on  at  eleven  or  twelve  in  the  morning,  and  inca- 
pacitating the  patient  for  business.  These  com- 
plaints I  have,  in  more  than  half  the  instances 
which  have  come  under  my  notice,  been  able  to 
trace  to  a  cup  or  two  of  strong  coffee,  or  per- 
haps tea,  taken  for  breakfast,  without  a  particle 
of  nourishment,  or  at  least  without  a  sufficient 
quantity  to  support  the  system,  during  and  after 
the  stimulant  operation  of  these  active  liquids. 
I  have  generally  found  these  complaints  to  be 
most  effectually  relieved  by  the  simple  remedy 
of  eating,  and  cured  either  by  increasing  the 
quantity  and  quality  of  nourishment  taken  in  the 


312  ON   COFFEE   AND   TEA. 

morning,  or  by  exchanging  the  coffee  for  cocoa, 
chocolate  or  milk. 

TEA. 

The  tea-tree,  called  by  Linnaeus  THEA,  is  a 
native  of  Japan,  China,  Tonquin,  and  Assam. 
Linnaeus  believed  that  there  were  two  distinct 
species  of  this  genus,  producing  the  green  tea 
and  the  black,  to  which  he  has  given  the  names 
of  Thea  viridis  and  Thea  bohea,  and  distinguishes 
them  by  the  number  of  petals  in  their  flowers, 
the  one  having  six  petals,  the  other  nine.  But 
subsequent  observers  have  found  the  number  of 
these  organs  to  be  uncertain,  varying  from  three 
to  nine  ;  and  travellers  in  China  and  Japan,  as 
well  as  various  distinguished  botanists,  have  ar- 
rived at  the  opinion  that  the  different  kinds  of 
tea  brought  from  those  countries  are  the  product 
of  a  single  species,  subject  only  to  varieties  from 
the  influence  of  soil,  climate,  time  of  gathering, 
and  mode  of  preparation. 

The  tea-plant  is  a  small  evergreen  tree  or 
shrub,  of  the  height  of  six  or  eight  feet.  It 
grows  in  the  valleys,  and  on  the  sloping  sides 
of  mountains,  with  a  southern  exposure.  In 


ON   COFFEE   AND   TEA.  313 

Japan  it  is  planted  around  the  borders  of  fields, 
without  regard  to  the  kind  of  soil,  while  in  China, 
where  it  is  an  important  article  of  commerce, 
whole  fields  are  covered  with  it,  and  cultivated 
with  the  greatest  care.* 

*  The  origin  of  the  employment  of  tea  as  a  beverage,  amongst  the 
Chinese,  is  wrapped  in  the  ^obscurity  which  generally  belongs  to 
ancient  usages  ;  and  a  fabulous  tale  is  narrated,  as  to  its  intro- 
duction, which  has  had  credence  even  amongst  the  better  in- 
formed inhabitants  of  the  empire,  whilst,  as  is  usual  with  fables, 
it  has  been  imagined  to  have  some  allegorical  allusion,  which,  if 
explained,  would  satisfy  the  lover  of  antiquarian  lore.  The 
tale  is  thus  related  by  one  of  the  compilers  of  a  history  of 
China  : 

"Darma,  a  very  religious  prince,  and  third  son  of  an  Indian 
king,  named  Kosjusvo,  is  said  to  have  landed  in  China,  in  the 
year  510  of  the  Christian  era.  He  employed  all  his  care  and 
thought  to  diffuse  throughout  the  country  a  knowledge  of  God  and 
religion  ;  and,  being  desirous  to  excite  men  by  his  example,  im- 
posed on  himself  privations  and  mortifications  of  every  kind,  liv- 
ing in  the  open  air,  and  devoting  the  days  and  nights  to  prayer 
and  contemplation.  After  several  years,  however,  being  worn  out 
with  fatigue,  he  fell  asleep  against  his  will ;  and,  that  he  might 
faithfully  observe  his  oath,  which  he  thought  he  had  violated,  he 
cut  off  his  eyelids,  and  threw  them  on  the  ground.  Next  day, 
having  returned  to  the  same  spot,  he  found  them  changed  into  a 
shrub  which  the  earth  had  never  before  produced.  Having  eaten 
some  of  the  leaves  of  it,  he  found  his  spirits  exhilarated  and  his 
07 


314  ON   COFFEE   AND   TEA. 

When  the  plants  have  attained  their  third  year, 
the  collection  of  the  leaves  is  commenced.  It  is 
repeated  every  year  until  the  trees  are  seven 
or  eight  years  old,  after  which  they  are  cut 
down,  that  they  may  shoot  up  afresh  from  the 
roots,  —  a  process  which  increases  the  quantity 
of  leaves. 

The  leaves  are  carefully  picked  off,  one  by 
one.  In  Japan,  the  best  kind,  called  imperial 
tea,  is  collected  at  the  end  of  February,  or  the 
beginning  of  March,  before  the  leaves  are  fully 
unfolded.  This  tea  is  scarce  and  dear,  and  is 
drunk  by  the  grandees  and  rich  people  only. 
The  second  gathering  is  made  a  month  later, 
taking  indiscriminately  the  leaves  that  are  un- 
folded and  those  which  are  not.  Finally,  a  month 
after  this,  is  made  the  third  and  last  gathering, 
consisting  of  leaves  fully  grown,  which  furnish 

former  vigor  restored.  He  recommended  this  aliment  to  his  dis- 
ciples and  followers.  The  reputation  of  tea  increased,  and  after 
that  time  it  continued  to  be  generally  used.  Kaempfer,  in  his 
Jlm&nitates  Exotica,  gives  the  fife  with  a  portrait  of  this  saint, 
so  celebrated  in  China  and  Japan.  There  is  seen  at  the  feet  of 
Darma  a  reed,  which  indicates  that  he  had  traversed  the  seas  and 
rivers."  —  Siymond  on  Tea,  p.  12. 


ON   COFFEE   AND   TEA.  315 

the  poorest  and  lowest  priced  teas,  consumed 
by  the  common  people.  It  is  now  pretty  well 
understood  that  the  different  sorts  of  tea  im- 
ported into  this  country,  from  the  finest  green 
teas  to  the  poorest  bohea,  depend  for  their  dif- 
ference of  quality  very  much  upon  the  time  of 
their  gathering. 

The  process  of  gathering,  drying,  and  rolling 
the  leaves  is  very  laborious,  and  is  in  some  in- 
stances conducted  with  the  most  superfluous 
nicety.  In  Japan,  where  a  particular  mountain 
is  appropriated  to  raising  tea  for  the  exclusive 
use  of  the  emperor,  the  shrubs  are  washed  and 
cleansed  from  dust  every  day ;  the  men  em- 
ployed in  gathering  the  leaves  are  obliged  to 
bathe  themselves  two  or  three  times  a  day,  and 
to  wear  gloves  in  the  performance  of  their 
occupation. 

The  drying  and  rolling  of  the  leaves  is  per- 
formed by  the  Chinese  in  buildings  erected  for 
general  use.  Several  pounds  of  the  leaves  fresh 
gathered  are  placed  in  a  large,  shallow  pan  of 
thin  iron,  and  heated  over  a  furnace,  the  ope- 
rator shaking  and  turning  them  with  his  hands 
until  they  begin  to  crackle.  The  heat  thus 


316  ON   COFFEE   AND   TEA. 

applied  deprives  the  leaves  of  their  juice,  and 
with  it  of  the  inebriating  and  deleterious  prop- 
erties which  they  possess  while  green.  After  the 
leaves  are  thoroughly  roasted,  they  are  taken  out 
with  wooden  shovels,  and  delivered  to  the  rollers. 
These  persons  roll  them  rapidly  and  with  a  regu- 
lar motion,  with  the  palms  of  their  hands,  upon 
tables  covered  with  fine  mats,  until  they  acquire 
the  form  in  which  we  see  them  imported.  This 
operation  produces  an  almost  insupportable  burn- 
ing in  the  hands,  which  is  aggravated  by  a  yel- 
lowish inflammatory  juice  pressed  out  from  the 
leaves.  Nevertheless,  it  is  necessary  to  continue 
the  operation  until  the  leaves  are  completely 
cold,  for  they  cannot  be  rolled  except  when  hot, 
and,  in  order  that  they  should  not  unroll,  it  is 
necessary  that  they  should  cool  under  the  hands. 
The  more  rapid  the  cooling,  the  better  they  are 
rolled,  and  on  this  account  the  workmen  agitate 
the  air  with  a  kind  of  fan.  But,  in  spite  of  this 
precaution,  a  great  number  of  the  leaves  unroll 
themselves,  and  are  obliged  to  be  separated  and 
roasted,  and  rolled  several  successive  times  before 
they  are  in  order  to  be  packed. 

In  order  that  the  tea  should  keep  well,  it  must 


ON    COFFEE   AND    TEA.  317 

be  inclosed  in  vessels  which  are  air-tight,  Ksemp- 
fer  assures  us  that  the  tea  brought  into  Europe 
is  always  injured  in  quality,  and  never  retains 
the  fine  flavor  and  delicate  perfume  which  it  has 
in  its  own  country.  The  Japanese  inclose  their 
tea  in  vessels  of  tin,  which,  if  large,  are  placed 
in  savin  boxes  having  their  cracks  closed  with 
paper  within  and  without.  The  tea  imported  to 
this  country  from  China,  it  is  well  known,  comes 
in  tight  wooden  chests,  lined  with  sheet-lead 
hermetically  soldered.  It  is  packed  in  these 
chests,  by  the  Chinese,  by  stamping  it  down  with 
their  bare  feet. 

Some  writers  have  asserted  that  the  tea  is 
roasted  upon  plates  of  copper,  and  that  its  color 
is  owing  to  verdigris,  with  which  it  thus  be- 
comes impregnated.  But  those  travellers  who 
are  most  entitled  to  credit,  affirm  that  the  plates 
are,  without  exception,  of  iron  ;  and  Dr.  Lettson, 
after  a  great  number  of  experiments  made  with 
chemical  tests,  never  detected  any  trace  of  cop- 
per ;  so  that  this  suspicion  appears  to  be  void 
of  foundation. 

Among  the  Chinese  tea  is  drunk  in  a  variety 
of  ways.  Some  use  it  as  we  do,  in  the  form  of 
'27* 


318  ON  COFFEE   AND   TEA. 

an  infusion ;  others  take  it  in  the  form  of  fine 
powder,  mixed  with  boiling  water.  The  common 
or  laboring  people  are  said  to  use  it  in  decoction, 
several  handfuls  of  the  ordinary  kinds  of  tea 
being  boiled  in  a  kettle  of  water  until  the 
strength  is  extracted.  This  is  taken  by  them  as 
their  common  drink  for  assuaging  thirst,  and 
diluting  meals. 

Tea  was  first  introduced  into  Europe  by  the 
Dutch,  before  the  middle  of  the  seventeenth  cen- 
tury ;  and  several  physicians  of  eminence,  either 
from  conviction  of  its  utility,  or  perhaps  for  the 
more  substantial  reason  of  a  pecuniary  reward, 
published  warm  eulogies  in  its  favor.  From  this 
time  its  adoption  was  rapid  in  all  the  countries 
of  Europe,  and  it  is  now  a  common  article  of  diet 
with  both  rich  and  poor.* 

*  Nicolaus  Tulpius  was  about  the  first  medical  man  who  wrote 
professionally  upon  tea,  but  his  were  not  original  observations  ; 
they  were  the  opinions  of  the  most  eminent  men  he  had  collected 
to  give  to  the  world.  But  in  1678  appeared  the  first  edition  of  a 
book,  which  speedily  ran  through  three  large  impressions,  and  had 
a  considerable  influence  upon  the  introduction  of  tea.  It  was 
entitled  Cornelia  Bontekoe,  Tractaat  van  het  excellenste  Kruyd 
Thee.  Although  this  work  was,  from  the  extravagance  of  its 
commendations  on  tea,  severely  handled  by  some  of  the  critics,  it 


ON   COFFEE   AND   TEA.  319 

In  regard  to  the  medicinal  qualities  of  tea,  and 
its  general  influence  upon  the  health  of  those 
who  take  it,  reports  and  opinions  are  various  and 

was  translated  into  many  languages,  and  quoted  as  the  highest 
authority.  He  pronounced  tea  to  be  the  infallible  cause  of  health, 
and  that  if  mankind  could  be  induced  to  drink  a  sufficient  quan- 
tity of  it,  the  innumerable  ills  to  which  man  is  subject  would  not 
only  be  diminished,  but  entirely  unknown.  He  thinks  that  two 
hundred  cups  daily  would  not  be  too  much.  He  is  said  to  have 
been  rewarded  for  his  judgment  by  the  liberality  of  the  Dutch 
East  India  Company.  Heydentrik  Overcamp,  who  wrote  the  life 
of  Bontekoe,  states  that  his  inducement  to  write  was  to  recom- 
mend himself  to  his  fellow-citizens,  and  to  defend  himself  against 
his  colleagues,  who  did  not  follow  his  theory  or  his  practice. 
Etmiiller  recommended  tea  as  a  fine  stomachic  cephalic  and  anti- 
nephritic.  Pechlin  wrote  a  dialogue  on  tea,  which  he  entitled 
Theophilus  Bibaculus,  and  several  poets  indulged  themselves  in 
its  praise.  Petit  wrote  a  poem  ;  Peter  Francius,  two  Anacreon- 
tics ;  Heinrich,  a  Doric  Melydrion  ;  and  our  poet-laureate,  Tate, 
joined  the  melodious  bards.  Whilst  it  met  with  so  much  appro- 
bation, there  were  likewise  those  who  were  not  equally  satisfied 
with  its  merits.  Boerhaave,  Van  Swieten,  and  others,  attempted 
to  stem  the  tide  that  was  setting  in  its  favor,  but  they  have 
proved  themselves  incapable  of  resisting  the  general  impression  ; 
for  no  beverage  that  has  ever  yet  been  introduced  sits  so  agree- 
ably on  the  stomach,  so  refreshes  the  system,  soothes  nervous 
irritation  after  fatigue,  or  forms  a  more  grateful  repast.  It  con- 
tributes to  the  sobriety  of  a  nation  ;  it  imparts  all  the  charms  to 
society  which  spring  from  the  enjoyment  of  conversation,  with- 


320  ON   COFFEE   AND  TEA. 

contradictory.  Such  is  the  diversity  of  tempera- 
ments  and  constitutions,  that  it  cannot  otherwise 
happen  than  that  an  article  of  diet  which  is  taken 

out  that  excitement  which  follows  upon  a  fermented  drink. — 
Sir/mend,  p.  94. 

The  introduction  of  tea-drinking  into  England  has  been  as- 
cribed to  Lord  Arlington  and  Lord  Orrery,  and  the  year  1666,  the 
annus  mirabilis  of  Dryden,  has  been  assigned  as  the  exact  date  ; 
but  in  the  diary  of  Mr.  Pepys,  secretary  to  the  Admiralty,  the 
following  is  registered  :  "I  sent  for  a  cup  of  tea,  a  Chinese  drink, 
of  which  I  had  never  drank  before."  In  the  diary  of  Henry, 
Earl  of  Clarendon,  there  is  a  memorandum :  "  Pere  Couplet 
supped  with  me,  and  after  supper  we  had  tea,  which  he  said  was 
really  as  good  as  any  he  drank  in  China."  The  first  historical 
record,  however,  is  an  act  of  Parliament,  passed  in  the  year  1660, 
12  Carl.  II.  c.  23,  which  enacts  that  a  duty  should  be  laid  of  eight 
pence  per  gallon  on  all  tea  made  and  sold  in  coffee-houses  ;  which 
were  visited  twice  daily  by  officers,  whose  duty  it  was  to  ascertain 
what  quantity  had  been  made. 

From  An  exact  Description  of  the  Growth,  Quality,  and  Vir- 
tues of  the  Leaf  Tea,  by  Thomas  Garway,  in  Exchange  Alley,  near 
the  Royal  Exchange,  in  London,  Tobacconist,  and  Seller  and  Re- 
tailer of  Tea  and  Coffee  ;  published  about  1660  : 

"  Tea  is  generally  brought  from  China,  and  groweth  there 
upon  little  shrubs  and  bushes,  the  branches  whereof  are  well  gar- 
nished with  white  flowers,  that  are  yellow  within,  of  the  bigness 
and  fashion  of  sweet-brier,  but  in  smell  unlike,  bearing  thin  green 
leaves  about  the  bigness  of  scordium,  myrtle,  or  sumack,  and  is 
judged  to  be  a  kind  of  sumack.  The  said  leaf  is  of  such  known 


ON   COFFEE   AND   TEA.  321 

by  one  person  with  impunity,  and  even  with 
benefit,  shall  in  another  occasion  disagreeable 
and  even  serious  consequences.  Dr.  Cullen  con- 
virtues,  that  those  very  nations,  so  famous  for  antiquity,  knowl- 
edge and  wisdom,  do  frequently  sell  it  among  themselves  for 
twice  its  weight  in  silver  ;  and  the  high  estimation  of  the  drink 
made  therewith  hath  occasioned  an  inquiry  into  the  nature 
thereof,  amongst  the  most  intelligent  persons  of  all  nations  that 
•  have  travelled  in  those  parts,  who,  after  exact  tryal  and  experi- 
ence by  all  wayes  imaginable,  have  commended  it  to  the  use  of 
their  several  countries,  and  for  its  virtues  and  operations,  par- 
ticularly as  folio weth,  viz. : 

"  The  quality  is  moderately  hot,  proper  for  winter  and  summer. 
The  drink  is  declared  to  be  most  wholesome,  preserving  in  perfect 
health  until  extreme  old  age. 

"  The  particular  virtues  are  these  : 

"  It  maketh  the  body  active  and  lusty. 

"  It  helpeth  the  headache,  giddiness  and  heaviness  thereof. 

"  It  remOveth  the  obstructions  of  the  spleen. 

"  It  taketh  away  the  difficulty  of  breathing,  opening  obstruc- 
tions. 

"It  is  good  against  tipitude,  distillations,  and  cleareth  the 
sight. 

"It  removeth  lassitude,  and  cleanseth  and  purifieth  acrid 
humors,  and  a  hot  liver. 

"  It  is  good  against  crudities,  strengthening  the  weakness  of  the 
ventricle  or  stomach,  causing  good  appetite  and  digestion,  and 
particularly  for  men  of  corpulent  body,  and  such  as  are  great 
eaters  of  flesh. 


322  ON   COFFEE   AND   TEA. 

sidered  tea  as  decidedly  narcotic  and  sedative  in 
its  effects;  but  the  most  superficial  observer 
must  see  that  tea  has  very  little  in  common  with 

"  It  vanquisheth  heavy  dreams,  easeth  the  frame,  and  strength- 
eneth  the  memory. 

"  It  overcometh  superfluous  sleep,  and  prevents  sleepiness  in 
general,  a  draught  of  the  infusion  being  taken  ;  so  that,  without 
trouble,  -whole  nights  may  be  spent  in  study  without  hurt  to  the 
body,  in  that  it  moderately  healeth  and  bindeth  the  mouth  of  the 
stomach. 

"It  prevents  and  cures  agues,  surfeits  and  fevers,  by  infusing 
a  fit  quantity  of  the  leaf,  thereby  provoking  a  most  gentle  vomit 
and  breathing  of  the  pores,  and  hath  been  given  with  wonderful 
success. 

"  It  (being  prepared  and  drank  with  milk  and  water)  strength- 
eneth  the  inward  parts,  and  prevents  consumption  ;  and  power- 
fully assuageth  the  pains  of  the  bowels,  or  griping  of  the  guts, 
and  looseness. 

"  And  that  the  virtues  and  excellences  of  this  leaf  and  drink 
are  many  and  great,  is  evident  and  manifest  by  the  high  esteem 
and  use  of  it  (especially  of  late  years)  among  the  physicians  and 
knowing  men  of  France,  Italy,  Holland,  and  other  parts  of 
Christendom  ;  and  in  England  it  hath  been  sold  in  the  leaf  for  six 
pounds,  and  sometimes  for  ten  pounds  the  pound  weight  ;  and  in 
respect  of  its  former  scarceness  and  dearness,  it  hath  been  only 
used  as  a  regalia  in  high  treatments  and  entertainments,  and 
presents  made  thereof  to  princes  and  grandees  till  the  year  1657. 
The  said  Thomas  Garway  did  purchase  a  quantity  thereof,  and 
first  publicly  sold  the  said  tea  in  leaf  and  drink,  made  according 


ON  COFFEE  AND   TEA.  323 

ether  narcotics.  The  excitement  which  it  pro- 
duces upon  the  mind  and  upon  the  organs  of 
digestion  is  of  a  durable  and  permanent  kind,  and 
it  never,  like  other  narcotics,  leaves  the  system 
in  a  state  of  somnolency  and  intoxication.  These 

to  the  directions  of  the  most  knowing  merchants  and  travellers  in 
those  eastern  countries  ;  and  upon  knowledge  and  experience  of 
the  said  Garway's  continued  care  and  industry  in  obtaining  the 
best  tea,  and  making  drink  thereof,  very  many  noblemen,  phy- 
sicians, and  merchants,  and  gentlemen  of  quality,  have  ever  since 
sent  to  him  for  the  said  leaf,  and  daily  resort  to  his  house  in  Ex- 
change Alley  aforesaid,  to  drink  the  drink  thereof. 

"  And  that  ignorance  nor  envy  may  have  no  ground  or  power 
to  report,  or  suggest,'  that  what  is  here  asserted,  of  the  virtues 
and  excellences  of  this  precious  leaf  and  drink,  hath  more  of  design 
than  truth,  for  the  justification  of  himself  and  the  satisfaction  of 
others,  he  hath  here  enumerated  several  authors,  who,  in  their 
learned  works,  have  expressly  written  and  asserted  the  same  and 
much  more,  in  honor  of  this  noble  leaf  and  drink,  viz.,  Bontius, 
Riccius,  Jarricus,  Almeyda,  Horstius,  Alvarez  Semeda,  Martini- 
vus  in  his  China  Jltlas,  and  Alexander  de  Rhodes  in  his  Voyage 
and  Missions,  in  a  large  discourse  of  the  ordering  of  this  leaf, 
and  the  many  virtues  of  the  drink  ;  printed  at  Paris,  1653,  part 
x.  chap.  13. 

"  And  to  the  end  that  all  persons  of  eminency  and  quality, 
gentlemen  and  others,  who  have  occasion  for  tea'  in  leaf,  may  be 
supplied,  these  are  to  give  notice  that  the  said  Thomas  hath  tea 
to  sell,  from  sixteen  to  fifty  shillings  in  the  pound."  —  Sigmond, 
p.  96,  &c. 


324  ON   COFFEE   AIST)   TEA. 

remarks  are  to  be  understood  of  tea  in  the  state 
in  which  we  consume  it,  that  is,  the  state  of  per- 
fect dryness.  In  its  green  or  recent  state,  it  is 
said  to  possess  a  decided  narcotic  quality,  capa- 
ble of  producing  intoxication  and  other  delete- 
rious consequences.  This  property,  however, 
is  of  a  volatile  nature,  and  is  lost  in  the  process 
of  drying  and  by  a  few  months'  age. 

A  crystalline,  volatile,  salefiable  substance  has 
been  found  in  tea  by  chemists,  and  by  them 
named  Theine.  It  is  said  to  exist  in  combina- 
tion with  tannic  acid  in  the  leaves,  and  to  be 
identical  in  its  chemical  composition  with  caf- 
feine, the  alkaloid  found  in  coffee.  Its  chemical 
character  has  led  Liebig  to  suppose  that,  when 
used  as  an  article  of  diet,  it  may  promote  the 
formation  of  taurine,  a  peculiar  compound  in  the 
bile. 

Tea,  as  it  is  brought  to  us  in  its  dry  state,  has 
the  effect  of  creating  a  lightness  and  exhilaration 
of  mind,  an  increased  action  of  the  stomach  in 
the  process  of  digestion,  and,  above  all,  a  vigi- 
lance and  increased  power  of  mental  exertion. 
Dr.  Johnson  is  recorded  to  have  made  the  teapot 
the  companion  of  his  lucubrations,  and  to  have 


ON   COFFEE   AND   TEA.  325 

taken  immense  quantities  of  its  contents,  to  sus- 
tain the  energies  of  his  powerful  mind  during  the 
prodigious  labors  which  he  accomplished.  In  its 
other  properties  tea  is  astringent  and  antiseptic. 
It  visibly  produces  no  injurious  effect  upon  the 
generality  of  persons  who  take  it  from  infancy 
to  old  age.  It  is  remarked  by  Desfontaines,  that 
no  vegetable  is  known,  the  infusion  of  which  can 
be  drunk  so  often,  and  in  such  large  quantities, 
without  disgust.  The  Chinese  regard  it  as  highly 
salubrious.  They  mix  with  it  neither  milk  nor 
sugar,  but  drink  it  pure,  sometimes  holding  a 
piece  of  sugar  in  the  mouth.  The  constant  use 
which  this  people  have  made  of  it  for  so  many 
ages  seems  to  prove  that,  when  rightly  prepared, 
it  is  destitute  at  least  of  injurious  properties. 
Professor  Kalm  states  that  tea  is  the  best  cor- 
rector of  bad  water,  and  that  he  derived  from  it 
great  comfort  and  benefit  during  the  illness  and 
inconvenience  of  a  long  sea-voyage.  It  is,  in  fact, 
one  of  the  best  remedies  for  slight  sea-sickness. 
An  extract  made  of  tea  is  in  high  repute  as  a 
medicine  in  China,  and  is  said  to  remove  obstruc- 
tions and  promote  perspiration.  Dr.  Lettsom 
states  that  tea  given  in  fine  powder,  in  doses  of 
28 


326  OX  COFFEE   AND   TEA. 

thirty  grains  once  in  three  or  four  hours,  pro- 
duced nausea  and  diaphoresis,  and  appeared  to 
diminish  the  heat  accompanying  inflammatory 
complaints.  The  finer  and  more  green  is  the 
tea,  the  more  powerful  are  its  specific  effects. 

Nevertheless,  a  variety  of  injurious  conse- 
quences have  been  ascribed  to  tea,  and  many 
no  doubt  have  arisen,  either  from  its  abuse  or 
from  the  idiosyncrasies  of  those  who  have  been 
the  subjects  of  its  influence.  Some  persons  com- 
plain that,  after  taking  freely  of  tea,  a  nervous 
agitation  of  the  whole  frame  commences.  The 
hands  tremble,  so  as  to  be  incapable  of  writing  ; 
the  limbs  experience  a  loss  of  power,  and  per- 
form their  office  with  difficulty  ;  at  the  same  time 
a  confusion  of  ideas  incapacitates  the  mind  for 
any  close  or  active  train  of  thinking.  There  are 
even  some  persons  in  whom  tea  produces  great 
nausea  and  sickness,  with  spasmodic  pains  of  the 
stomach  and  bowels,  and  an  uncontrollable  agita- 
tion of  spirits  on  the  least  hurry,  noise  or  disturb- 
ance. These  symptoms,  however,  are  the  effect 
of  some  peculiarity  in  the  constitution,  a  great 
mobility  of  the  nervous  system,  and  generally  of 
a  slender,  enfeebled  or  effeminate  frame.  They 


ON   COFFEE   AISTD   TEA.  327 

may,  however,  arise  in  all  persons  from  an  ex- 
cessive use,  either  as  it  respects  the  quantity  or 
strength  of  the  tea,  or  the  want  of  nourishment 
taken  at  the  same  time.  I  believe  the  number 
of  persons  will  be  found  to  be  exceedingly  small 
who  cannot  take  tea  in  moderate  quantities,  and 
accompanied  by  food,  without  any  inconvenience 
whatever. 

The  inquiry  is  very  often  made  of  physicians, 
Which  is  the  most  wholesome  article  of  food, 
coffee  or  tea  ?  The  prejudices  of  most  persons 
are  ranged  on  one  side  or  the  other  of  this  ques- 
tion, and  even  practitioners  themselves  are  apt  to 
fall  into  one  or  the  other  extreme.  One  of  the 
oldest  and  most  distinguished  physicians  of  this 
city,*  being  asked  what  was  the  difference  in 
effect  between  tea  and  coffee,  replied,  that  "  one 
is  poison,  and  the  other  not."  A  physician  of 
equal  eminence,  in  Philadelphia,!  decided  on  the 
properties  of  the  two  with  equal  positiveness, 
taking,  however,  the  opposite  side  of  the  ques- 
tion. The  truth  is,  that  there  are  scarcely  any 
two  substances  in  the  materia  medica  which  bear 

*  Dr.  S.  Danforth.  t  Dr.  B.  S.  Barton. 


328  ON   COFFEE  AND   TEA. 

a  closer  relation,  or  more  nearly  resemble  each 
other,  in  their  properties,  than  coffee  and  tea. 
Tea  is  more  astringent  than  coffee,  and  coffee  of 
the  strength  commonly  used  is  somewhat  more 
stimulating  than  tea,  —  otherwise  the  differences 
which  have  been  ascribed  to  them  have  mostly 
arisen  from  the  accidental  opinions  of  individu- 
als, whose  taste  and  idiosyncrasies  have  rendered 
them  fond  of  the  one  and  averse  to  the  other. 


REPORT 

OP    THE 

ACTION    OF     COCHITUATE    WATER 
ON  LEAD   PIPES, 

AND   THE  INFLUENCE   OF  THE  SAME   ON   HEALTH. 


[From  the  American  Journal  of  Medical  Sciences  for  1852.] 

THE  committee  appointed  by  the  Society  of 
Medical  Improvement  in  Boston,  for  investigat- 
ing the  question  of  the  occurrence  of  any  diseases 
attributable  to  the  presence  of  lead  in  the  aque- 
duct water  introduced  into  the  city  from  the 
Cochituate  Lake,  report  as  follows  :  — 

That  from  an  extensive  inquiry  among  physi- 
cians, and  also  from  the  bills  of  mortality,  they 
are  led  to  believe  that  the  health  of  the  city  of 
Boston  has  been  uncommonly  good  during  sev- 
eral years  since  the  introduction  of  Cochituate 
water  ;  and  they  have  not  learned  that  any  well- 
marked  cases  of  the  diseases  usually  attributed  to 
28* 


330  ACTION   OF   COCHITUATE  WATER 

lead,  have  occurred,  which  were  not  traceable  to 
some  other  cause  than  the  use  of  Cochituate 
water  drawn  from  leaden  pipes. 

It  appears,  from  the  experiments  of  Professor 
Horsford,  that  the  water  of  the  Schuylkill  and 
Croton  rivers,  and  of  Jamaica  and  Cochituate 
lakes,  acts  upon  the  surface  of  lead  so  as  to  take 
up  a  small  portion  of  that  metal  during  the 
first  two  or  three  days  of  its  contact.  But  after 
a  few  days  the  surface  of  the  lead  becomes  coated 
with  an  insoluble  compound  which  protects  the 
lead  for  the  most  part  from  the  further  action  of 
the  water.  Nevertheless,  traces  of  lead  are  re- 
ported to  have  been  found  by  various  chemists 
in  specimens  of  some  of  these  waters,  when 
greatly  reduced  by  evaporation. 

In  consequence  of  the  extensive  use  made  of 
lead  for  various  economical  purposes,  no  person 
in  civilized  society  can  expect  to  escape  from  the 
reception  of  that  metal  in  minute  quantities  into 
the  body.  The  presence  of  lead  in  the  paint  of 
dwelling-houses  and  furniture,  of  water-buckets 
and  other  culinary  apparatus,  in  vessels  made  of 
leaden  alloys  or  soldered  with  the  same,  in  the 
lining  of  tea-chests,  in  flint-glass,  and  in  the  glaz- 


ON  LEAD  PIPES.  331 

ing  of  coarse  pottery,  furnishes  but  a  part  of  the 
examples  which  indicate  our  exposure  to  receive 
this  metal  in  our  daily  food.  To  these  examples 
it  may  be  added  that  physicians  give  lead  to 
their  patients  sometimes  for  weeks  successively, 
and  apply  solutions  and  solid  compounds  of  the 
metal  to  absorbing  surfaces  for  longer  periods ; 
that  persons  are  known  to  carry  shot  and  bullets 
in  their  flesh  during  a  long  life  ;  and,  finally,  that 
reliable  chemists  testify  that  lead  naturally  exists 
in  the  solids  and  fluids  of  man,  and  in  those  of 
some  of  the  animals  on  which  he  feeds. 

From  all.  these  facts  we  are  authorized  to  draw 
the  conclusion  that,  in  the  present  state  of  our 
knowledge,  the  presence  of  lead  in  a  very  minute 
amount,  like  the  presence  of  other  substances  in 
infinitesimal  quantities,  is  inoperative  upon  the 
living  body. 

It  is  a  general  law,  known  to  medical  men,  and 
to  which  there  are  not  many  exceptions,  that 
diseases  and  symptoms  produced  by  specific  me- 
tallic agents,  such  as  mercury,  lead,  and  arsenic, 
do  not  cease  until  after  the  withdrawal  of  those 
agents.  But  it  appears  from  the  records  of  the 
Massachusetts  General  Hospital,  during  the  last 


332  ACTION   OF   COCHITUATE  WATER 

twenty  years,  as  well  as  from  the  private  experi- 
ence of  physicians,  that  many  cases  of  lead  colic 
and  paralysis,  acquired  by  persons  who  work  in 
that  metal,  have  got  well  under  the  daily  use  of 
water  delivered  from  leaden  pipes.  This  would 
not  probably  have  been  the  case  did  the  water 
contain  any  deleterious  amount  of  lead  in  solu- 
tion or  suspension. 

The  principal  diseases  ascribed  by  Tanquerel, 
and  some  subsequent  writers,  to  the  presence  of 
lead,  are  colic,  paralysis,  arthralgia  and  encepha- 
lopathy.  Of  these  the  committee  have  not  been 
able  to  learn  that  there  has  been  any  sensible 
increase  in  this  city  since  the  introduction  of 
Cochituate  water.  Of  lead  colic,  but  one  case 
has  entered  the  hospital  during  the  last  two 
years,  which  is  a  smaller  proportion  than  the 
average  of  the  preceding  twenty  years.  Of  lead 
paralysis  there  have  been  but  two  cases  within 
the  same  period,  both  occurring  to  workmen  in 
lead.  Of  arthralgia,  or  pain  in  the  joints  or  limbs 
directly  traceable  to  lead,  it  is  believed  there 
have  not  been  a  sufficient  number  of  cases  at  any 
time  to  attract  extensively  the  notice  of  our  phy- 
sicians. As  to  encephalopathy, — a  general  term 


ON  LEAD   PIPES.  333 

used  by  some  writers  to  express  cerebral  disease, 
and  including  coma,  delirium,  convulsions,  &c., — 
there  is  apparently  no  more  reason  for  attribut- 
ing it  to  lead,  than  consumption,  fever,  or  any 
other  common  disease  which  may  happen  to 
occur  among  lead  workmen. 

It  is  obvious,  to  a  medical  reader,  that  many 
of  the  cases  detailed  by  writers  on  lead  diseases 
are  coincidences  rather  than  consequences ;  and 
therefore  do  not  furnish  a  ground  for  general 
laws.  Such  is  the  case  when  persons  have  been 
supposed  to  have  contracted  lead  diseases  by 
sleeping  in  newly-painted  apartments,  where,  un- 
less the  lead  were  volatile,  it  could  not  leave  the 
walls  to  enter  the  bodies  of  the  patients.  It  is 
also  the  case  when  solitary  examples  of  common 
diseases  are  ascribed  to  lead,  when  it  is  known 
that  they  more  frequently  result  from  different 
causes.  It  is  also  often  the  case  when  the  reports 
of  credulous  and  incompetent  observers  are  re- 
ceived as  scientific  authority. 

In  a  late  "  English  Report  by  the  Government 
Commissioners  on  the  Chemical  Quality  of  the 
Supply  of  Water  to  the  Metropolis  "  of  London, 
made  in  1851,  by  Drs.  Th.  Graham,  W.  A.  Miller, 


334  ACTION   OF   COCHITUATE  WATER 

and  A.  W.  Hoffman,  men  of  high  standing  in  the 
scientific  world,  an  investigation  is  made  of  the 
condition  of  the  various  waters  now  supplied  to 
that  city.  In  this  Report,  the  commissioners 
state  (page  32)  that  "  no  recent  or  authenticated 
case  can  be  cited  of  the  health  of  any  of  the  nu- 
merous towns,  lately  supplied  with  soft  water, 
being  affected  by  the  use  of  leaden  distributing- 
tubes."  Again,  on  page  33,  the  commissioners 
say :  "  We  are  disposed,  therefore,  to  conclude 
that  the  danger  from  lead,  in  towns  supplied  with 
water,  has  been  overrated  ;  and  that,  with  a  sup- 
ply from  the  water  companies,  not  less  frequent 
than  daily,  no  danger  is  to  be  apprehended  from 
the  use  of  the  present  distributing  apparatus, 
with  any  supply  of  moderately  soft  water  which 
the  metropolis  is  likely  to  obtain." 

On  the  present  occasion  it  is  by  no  means  in- 
tended to  deny  the  well-known  fact,  that  certain 
acid  liquors,  also  that  the  water  of  certain  springs 
and  wells,  may  and  do  act  upon  and  even  dissolve 
lead  in  such  quantities  as  to  prove  injurious  to 
human  health.  It  is  also  possible  that,  at  certain 
seasons,  and  under  certain  circumstances,  the  soft 
water  of  lakes  and  rivers  may  contain  organic  or 


ON  LEAD   PIPES.  335 

other  products,  which  may  take  up  in  solution  a 
minute  portion  of  the  pipes  through  which  they 
pass.  And  it  may  even  be  conceded  as  possible 
that  a  few  susceptible  and  predisposed  individ- 
uals will  get  lead  diseases  while  using  this  water. 
Nevertheless,  lead  is  a  very  convenient  material 
to  be  used  in  aqueducts.  It  is  more  cheaply 
manufactured,  more  conveniently  applied,  and 
more  readily  repaired,  than  any  other  material ; 
and  while  this  is  the  case,  mankind  will  not  be 
prevented  from  employing  it.  The  general  la,w 
derived  from  the  experience  of  the  large  cities 
of  this  country  and  of  Europe  is,  that  its  employ- 
ment for  the  conveyance  of  soft  water  is  safe. 
To  this  law  the  few  recorded  cases  of  disease,  if 
genuine,  must  be  regarded  as  exceptions.  And 
it  should  be  borne  in  mind  that  nearly  all  the 
great  agents  which  minister  to  the  physical  hap- 
piness and  improvement  of  man  are  fraught  with 
more  or  less  danger.  Ships  and  railroads,  fire 
and  water,  food,  drink  and  medicine,  destroy  an- 
nually multitudes  of  our  species.  Nevertheless, 
all  these  agents  increase  every  year  in  use,  with 
the  increase  of  wealth  and  civilization.  And  as 
a  humble  example  under  the  same  law,  it  is  not 


336  ACTION   OF   COCHITUATE  WATER. 

probable  that  the  leaden  aqueduct  will  be  aban- 
doned, on  account  of  the  inconsiderable  risk 
which  it  may  involve  of  occasioning  disease. 
From  the  present  state  of  our  knowledge,  we 
are  authorized  to  conclude  that  the  insurance  on 
a  citizen  of  Boston,  New  York,  Philadelphia,  or 
London,  against  lead  colic,  is  probably  Avorth 
much  less  than  his  insurance  would  be  on  a 
voyage  across  the  Atlantic,  or  on  a  railroad  for 
twenty  miles. 


ON 

THE  POISONOUS  PROPERTIES 

OF 

CERTAIN    AMERICAN    SPECIES 
OF    RHUS. 


SEVERAL  species  of  Rims,  or  Sumac,  growing 
in  the  United  States,  possess  a  peculiar  property 
of  exciting,  by  their  contact,  a  specific  cutane- 
ous disease  in  certain  predisposed  or  susceptible 
persons.  A  great  majority  of  persons  are  exempt 
from  liability  to  this  disease;  yet  some  individuals 
receive  from  the  contact,  and  even  the  exhala- 
tion of  those  shrubs,  a  serious  and  distressing 
eruptive  affection  of  the  skin. 

The  fihus  vernix  of  Linnseus,  called  by  Decan- 
dolle  EJius  venenata,  is  a  handsome  shrub,  with 
smooth  foliage  and  reddish  leaf-stalks,  common 
in  swamps  and  low  grounds  throughout  the 
United  States,  and  rising  to  the  height  of  ten  or 
29 


338  ON   THE   POISONOUS   PROPERTIES   OF 

fifteen  feet.  It  is  variously  denominated  Swamp 
Sumac,  Poison  Ash,  Dogwood,  £c.,  in  different 
parts  of  the  country.  A  figure  and  description 
of  it  are  given  in  Bigelow's  Medical  Botany,  vol. 
I.,  p.  96.  It  so  closely  resembles  a  tree  growing 
in  Japan,  from  which  the  varnish  is  made  which 
bears  the  name  of  that  country,  that  botanists  are 
not  agreed  on  the  question  of  their  identity. 
Both  are  poisonous,  and  both  are  capable  of 
affording  a  black  varnish. 

If  an  incision  be  made  in  the  bark  of  the 
American  shrub,  in  spring  or  autumn,  a  quantity 
of  thick  viscid  fluid  immediately  exudes,  and 
sometimes  with  such  rapidity  as  to  drop  off  before 
it  can  be  collected.  This  juice  has  an  opaque, 
whitish  appearance,  and  a  strong,  penetrating, 
disagreeable  smell.  On  exposure  to  the  atmos- 
phere its  color  soon  changes  to  a  deep  black.  It 
is  extremely  slow  in  drying,  and  permanently 
retains  its  black  color.  It  is,  for  the  most  part, 
insoluble  in  water,  but  dissolves  partially  in 
alcohol,  and  still  more  in  ether.  Spread  upon 
surfaces  of  wood  or  cloth,  it  gives  them  a  black 
appearance ;  but,  in  my  experiments,  it  did  not 
dry  in  exposure  to  the  atmosphere  for  two 


CERTAIN    AMEEICAN    SPECIES    OF    RHUS.         339 

summer  months.  But  if  boiled  until  its  volatile 
part  is  expelled,  and  then  applied  warm  with  a 
brush,  it  assumes  a  glossy  jet-black  appearance, 
and  is  durable,  firm,  elastic,  and  not  affected  by 
moisture. 

-  A  distressing  cutaneous  disease  ensues  in 
many  persons  from  the  contact  and  even  from 
the  effluvium  of  this  shrub.  The  poisonous  in- 
fluence which  produces  this  affection  is  common 
to  several  other  species  of  Rhus,  also  to  the 
Cashew-nut,  the  Manchineel,  and  some  other 
vegetables.  The  poison  is  extremely  various 
in  its  action  upon  persons  of  different  idiosyn- 
crasies. Some  cannot  come  within  the  atmos- 
phere of  the  shrub  without  suffering  violent  con- 
sequences. Others  are  but  slightly  affected  by 
handling  it,  and  some  can  even  rub,  chew  and 
swallow  the  leaves  without  inconvenience. 

The  most  formidable  cases  in  persons  subject 
to  this  poison  usually  commence,  within  twenty- 
four  hours  after  the  exposure.  The  symptoms 
are  generally  ushered  in  by  a  sense  of  itching, 
with  a  tumefaction  of  the  hands  and  face.  If  the 
skin  be  examined  at  this  stage,  a  minute  vesic- 
ular eruption,  like  eczema,  can  be  discovered  in 


340  ON   THE   POISONOUS   PROPEETIES   OP 

different  places,  particularly  between  the  fingers. 
The  swelling  gradually  extends  over  various 
parts  of  the  body,  affecting  most  those  parts 
which  have  been  exposed  to  the  poison.  The 
inflamed  surfaces  become  elevated,  acquiring  a 
vivid  redness,  attended  with  a  painful  burning 
sensation.  The  vesicles  enlarge  and  run  into 
each  other.  The  fluid  which  they  contain  is  at 
first  transparent  and  watery,  but  soon  becomes 
yellow  and  purulent.  As  the  vesicles  and  pus- 
tules break,  and  at  length  dry,  they  give  rise  to 
a  yellowish  and  brownish  incrustation.  The 
swelling  is  greatest  where  the  cellular  substance 
is  loose,  so  that  the  eyelids  are  frequently  closed 
by  it.  When  the  eruption  is  confluent  it  gives 
to  the  whole  countenance  a  shapeless  and  cada- 
verous appearance.  The  disease  is  usually  at  its 
height,  from  the  fourth  to  the  eighth  day,  after 
which  the  skin  and  incrustations  begin  to  sepa- 
rate from  the  diseased  parts,  and  the  symptoms 
gradually  subside.  I  have  never  known  it  to 
terminate  fatally,  and  it  is  not  usual  for  scars 
or  permanent  traces  of  the  eruption  to  remain. 
Some  persons,  however,  are  said  to  have  re- 
covered with  the  loss  of  the  hair  and  nails. 


CERTAIN  AMERICAN   SPECIES    OF   RHUS.         341 

The  Rhus  radicans,  like  the  Rhus  vernix,  is 
regarded  with  aversion  as  a  poisonous  plant,  and 
frequently  furnishes  cause  to  be  remembered  by 
susceptible  persons  who  become  exposed  to  its 
influence.  It  is  a  common  plant,  about  the 
borders  of  fields  and  road-sides,  running  over 
walls  and  climbing  trees,  and  usually  known  by 
the  names  of  Poison  ivy,  Poison  vine,  Poison 
creeper,  &c.  It  climbs  upon  tall  objects  in  its 
neighborhood  by  means  of  strong  lateral  rooting 
fibres,  which  project  in  great  numbers  from  its 
sides,  and  attach  themselves  to  the  bark  of  trees 
and  the  surface  of  stones.  The  adhesion  of  the 
vine  to  the  bark  of  trees  is  frequently  so  strong 
that  it  cannot  be  torn  off  without  breaking,  and 
sometimes  the  stems  are  completely  buried  in 
the  trunks  of  old  trees,  the  bark  having  grown 
over  and  enveloped  them.  When  it  does  not 
meet  with  an  elevated  prop,  the  plant  becomes 
stunted  in  its  growth,  is  more  branched,  and 
affects  a  spiral  mode  of  growth,  or  falls  to  the 
ground,  takes  root  and  rises  again.  The  erect 
variety  is  the  Rhus  toxicodendron  of  some 
botanists. 

If  a  leaf  or  stem  of  this  plant  is  broken  off,  a 
29* 


342  01?   THE  POISONOUS   PROPERTIES   OP 

yellowish  milky  juice  exudes  from  the  wounded 
extremity,  which,  after  a  short  exposure  to  the 
air,  becomes  of  a  dark-black  color.  If  applied  to 
linen,  it  produces  a  dark  spot,  which  is  not  after- 
wards eradicated  by  washing. 

The  contact  of  this  vine  produces  in  suscep- 
tible persons  an  eruption  similar  to  that  caused 
by  the  Rhus  vernix,  though  it  is  believed  that 
fewer  individuals  are  affected  by  it.  A  particu- 
lar account  of  this  disease  is  given  in  the  third 
volume  of  American  Medical  Botany,  already  re- 
ferred to.  Some  other  species  of  Rhus,  such  as 
Rhus  punilum  and  Rhus  aromaticum  are  con- 
sidered as  possessing  a  poisonous  quality  of  the 
same  character. 

The  disease  has  an  average  duration  of  a  week, 
more  or  less.  It  does  not  appear  to  be  shortened 
by  medical  treatment,  but  the  patient  is  rendered 
more  comfortable  by  soothing  emollient  appli- 
cations. It  sometimes  returns  on  the  trunk  and 
limbs  after  having  disappeared  from  the  face. 

I  apprehend  that  a  majority  of  persons  are  not 
liable  to  the  injurious  effects  of  the  poisonous 
sumacs.  Among  persons  residing  in  the  coun- 
try, exposures -must  occur  very  frequently,  from 


CERTAIN   AMERICAN  SPECIES   OF   EHUS.        343 

the  abundance  of  the  shrubs,  especially  of  Rlius 
radicans,  by  road-sides  and  elsewhere.  Very 
few,  however,  in  proportion  to  the  number  ex- 
posed, have  personal  experience  of  their  deleteri- 
ous effects.  In  those,  on  the  contrary,  in  whom 
a  constitutional  liability  to  the  poison  exists, 
the  disease  frequently  returns  several  times 
during  life,  notwithstanding  the  utmost  caution 
in  avoiding  exposure  to  its  causes.  A  gentleman 
residing  in  the  country  informed  me  that  he  had 
seven  times  been  poisoned  in  the  most  violent 
degree.  In  such  constitutions  a  slight  exposure 
is  sufficient  to  excite  the  disease.  I  have  known 
individuals  badly  poisoned  in  winter  from  the 
wood  of  the  Rhus  vernix  accidentally  burnt 
on  the  fire ;  and  others  have  made  the  same 
observation. 


ON     THE 

HISTORY  AND  USE  OF  TOBACCO. 


[Mostly  from  the  American  Medical  Botany,  TO!.  I.] 

IT  is  a  law  of  the  animal  economy,  that  the 
power  of  use  and  habit  is  capable  of  reconciling 
the  system  to  bear  with  impunity  what  in  its 
unaccustomed  state  proves  deleterious  or  even 
fatal.  It  is  a  weU-known  fact  that  many  sub- 
stances in  the  Materia  Medica  lose  their  effect 
after  the  continuance  of  their  use  for  a  certain 
length  of  time,  so  that,  if  we  would  realize  their 
original  operation,  we  must  increase  their  dose 
in  proportion  as  the  body  becomes  accustomed 
and  insensible  to  their  stimulus.  This  is  par- 
ticularly exemplified  in  the  narcotics.  Several 
of  these  substances,  which  at  first  are  not  only 
nauseous  and  disgusting  in  their  sensible  quali- 
ties, but  highly  injurious  in  their  influence  upon 


HISTORY  AND   USE   OF   TOBACCO.  345 

health,  are  so  changed  in  their  effect  by  habitual 
use,  as  to  become  to  those  who  employ  them  an 
indispensable  comfort  and  a  first-rate  luxury  of 
life. 

In  its  external  and  sensible  properties,  there  is 
no  plant  which  has  less  to  recommend  it  than 
the  common  tobacco.  Its  taste  in  the  green 
state  is  acrid,  nauseous  and  repulsive,  and  a 
small  quantity  taken  into  the  stomach  excites 
violent  vomiting,  attended  with  other  alarming 
symptoms.  Yet  the  first  person  who  had  cour- 
age and  patience  enough  to  persevere  in  its  use 
until  habit  had  overcome  his  original  disgust, 
eventually  found  in  it  a  pleasing  sedative,  a 
soother  of  care,  and  a  material  addition  to  the 
pleasures  of  life.  Its  use,  which  originated 
among  savages,  has  spread  into  every  civilized 
country ;  it  has  made  its  way  against  the  decla- 
mations of  the  learned,  and  the  prohibitions  of 
civil  and  religious  authority,  and  it  now  gives 
rise  to  an  extensive  branch  of  agriculture,  or  of 
commerce,  in  every  part  of  the  globe. 

Tobacco  was  in  use  among  the  aborigines  of 
America  at  the  time  of  its  discovery.  They 
employed  it  as  incense  in  their  sacrificial  fires, 


346  HISTORY  AND   USE   OF   TOBACCO. 

believing  that  the  odor  of  it  was  grateful  to  their 
gods.  The  priests  of  some  tribes  swallowed  the 
smoke  of  this  plant  to  excite  in  them  a  spirit  of 
divination,  and  this  they  did  to  a  degree  which 
threw  them  into  a  stupor  of  many  hours'  con- 
tinuance. When  recovered  from  this  jBt  of 
intoxication,  they  asserted  that  they  had  held  a 
conference  with  the  devil,  and  had  learned  from 
him  the  course  of  future  events.  Their  phy- 
sicians also  got  inebriated  with  the  smoke,  and 
pretended  that  while  under  the  influence  of  this 
intoxication  they  were  admitted  to  the  council 
of  the  gods,  who  revealed  to  them  the  event  of 
diseases. 

In  1559,  tobacco  was  sent  into  Spain  and 
Portugal  by  Hernandez  de  Toledo,  and  from 
thence  it  was  carried  into  France  as  a  curiosity 
by  Jean  Nicot  or  Nicotius,  ambassador  at  the 
court  of  Lisbon,  whose  name  is  now  immortal- 
ized by  its  application  to  this  genus  of  plants. 
From  this  period  the  use  of  tobacco  spread 
rapidly  through  the  continent,  and  in  half  a 
century  it  was  known  in  most  countries  in 
Europe.  The  rich  indulged  in  it  as  a  luxury  of 
the  highest  kind ;  and  the  poor  gave  themselves 


HISTORY   AND   USE   OP   TOBACCO.  347 

up  to  it  as  a  solace  for  the  miseries  of  life.  Its 
use  became  so  general  and  so  excessive,  that  in 
many  countries  the  constituted  authorities,  both 
of  church  and  state,  found  it  necessary  to  inter- 
pose, and  to  stop  the  extravagant  indulgence  in 
it  by  severe  prohibitions.  James  the  First  of 
England,  besides  writing  a  book  against  it,  called 
his  "  Counterblast  to  Tobacco,"  gave  orders  that 
no  planter  in  Virginia  should  cultivate  more  than 
one  hundred  pounds.  Pope  Urban  the  Eighth 
published  a  decree  of  excommunication  against 
ah1  who  took  snuff  in  the  church.  Smoking  was 
forbidden  in  Russia  under  penalty  of  having  the 
nose  cut  off.  In  Switzerland  a  tribunal  ( Cham- 
bre  du  tdbac]  was  instituted  for  the  express 
purpose  of  trying  transgressors  in  tobacco. 
A  Turk,  who  was  found  smoking  in  Constan- 
tinople, was  conducted  through  the  streets  of 
that  city  with  his  pipe  transfixed  through  his 
nose. 

Even  in  this  country,  where  the  use  of  tobacco 
was  originated,  we  find  our  puritanic  ancestors 
guarding  against  its  abuse  by  salutary  statutes. 
In  the  old  Massachusetts  colony  laws  is  an  act 
laying  a  penalty  upon  any  one  "  who  shall  smoke 


348  HISTORY   AKD    USE   OF   TOBACCO. 

tobacco  within  twenty  poles  of  any  house ;  •'  or 
who  shall  "  take  tobacco  in  any  inn  or  common 
victualling  house,  except  in  a  private  room,  so 
as  that  neither  the  master  of  the  said  house  nor 
any  other  guest  shall  take  offence  thereat."  In 
the  earliest  records  of  Harvard  University,  soon 
after  its  foundation,  is  a  regulation  of  this  kind  : 
"  No  scholar  shall  take  tobacco,  unless  permitted 
by  the  president,  with  the  consent  of  their 
parents  and  guardians,  and  on  good  reason  first 
given  by  a  physician,  and  then  in  a  sober  and 
private  manner." 

While  the  legal  authorities  in  various  parts  of 
the  world  took  upon  them  to  control  the  abuse 
of  this  fascinating  weed,  the  literati  of  different 
countries  entered  warmly  into  the  discussion  of 
its  merits  and  its  faults.  Among  its  advocates 
were  Castor  Duranti  and  Raphael  Thorius,  both 
of  whom  wrote  Latin  poems  expressly  in  its 
praise.  The  performance  of  the  latter  is  entitled 
a  "  Hymn  to  Tobacco,"  and  is  very  lavish  in  as- 
criptions to  this  plant,  w^hich  he  styles  the  "  gift 
of  heaven  and  the  ornament  of  earth."  So  warm 
were  the  prejudices  of  its  advocates,  that  it  ob- 
tained the  reputation  of  a  general  panacea,  and 


HISTORY  AND   USE   OF  TOBACCO.  349 

the  catalogue  of  diseases  which  it  was  announced 
to  cure  amounted  almost  to  a  complete  nosology. 

But  the  opinions  of  its  adversaries  were  not 
less  extravagant  upon  the  other  extreme.  It  is 
remarkable  that,  in  the  days  of  its  first  general 
introduction,  no  man  spoke  about  it  with  cool- 
ness and  indifference,  but  every  one  warmly 
espoused  its  censure  or  its  praise.  Camden,  in 
his  Life  of  Queen  Elizabeth,  says,  that  men  used 
tobacco  everywhere,  some  for  wantonness  and 
some  for  health's  sake  ;  and  that,  "  with  insatiable 
desire  and  greediness,  they  sucked  the  stinking 
smoke  thereof  through  an  earthen  pipe,  which 
they  presently  blew  out  again  at  their  nostrils ; 
so  that  Englishmen's  bodies  were  so  delighted 
with  this  plant,  that  they  seemed  as  it  were  de- 
generated into  barbarians." 

Dr.  Venner,  in  a  work  entitled  Via  recta  ad 
vitam  longam,  published  at  London  in  1638, 
gives  a  brief  summary  of  the  injuries  done  by 
tobacco.  "  It  drieth  the  brain,  dimmeth  the 
sight,  vitiateth  the  smell,  hurteth  the  stomach, 
destroyeth  the  concoction,  disturbeth  the  humors 
and  spirits,  corrupteth  the  breath,  induceth  a 
trembling  of  the  limbs,  exsiccateth  the  winde  pipe, 
30 


350  HISTORY  AOT>   USE   OF   TOBACCO. 

lungs  and  liver,  annoyeth  the  milt,  scorcheth  the 
heart,  and  causeth  the  blood  to  be  adusted.  In  a 
word,  it  overthroweth  the  spirits,  perverteth  the 
understanding,  and  confoundeth  the  senses  with 
sudden  astonishment  and  stupiditie  of  the  whole 
body." 

A  poetical  philippic,  called  "Tobacco  Battered," 
was  published  in  the  reign  of  King  James,  by 
Joshua  Sylvester,  in  which  he  compares  tobacco 
to  gunpowder,  and  pipes  to  guns ;  making  the 
mischief  of  the  two  equal.  But  the  most  cele- 
brated of  all  invectives  against  tobacco  was  the 
"  Counterblast "  of  King  James  I.  That  weak 
monarch  gave  vent  to  his  prejudices  against  this 
herb  in  a  publication,  in  which  he  professes  to 
disprove  all  the  alleged  grounds  for  the  toleration 
of  tobacco,  and  warns  his  subjects  in  a  most 
earnest  manner  not  to  sin  against  God,  and  harm 
their  own  persons  and  goods,  and  render  them- 
selves scorned  and  contemned  by  strangers,  who 
should  come  among  them,  by  persevering  in  a 
custom  "loathsome  to  the  eye,  hateful  to  the  nose, 
and  baneful  to  the  brain." 

Such  were  the  commotions  excited  by  the  in- 
troduction and  spreading  of  an  article,  the  use 


HISTORY    AND    USE    OF    TOBACCO.  351 

of  which  has  now  become  so  common  as  scarcely 
to  attract  notice.  This  article  is  the  product  of 
several  species  of  Nicotiana,  but  chiefly  of  the 
N.  tabacum  or  Virginia  tobacco,  and  the  N.  rus- 
tica,  sometimes  called  English  tobacco,  and  being 
the  sort  .which  Sir  Walter  Raleigh  introduced  at 
the  court  of  Queen  Elizabeth.  Another  species, 
N.fruticosa,  is  said  to  have  been  cultivated  in  the 
East  prior  to  the  discovery  of  America.  The 
Indians  on  the  banks  of  the  Missouri  and  Colum- 
bia rivers  cultivate  for  use  the  N.  quadrivalvis  of 
Pursh  and  Nuttall.  It  has  been  remarked  that  the 
tobacco  of  warm  climates  is  more  mild  in  its 
flavor,  while  that  raised  in  colder  latitudes  is 
more  strong  and  pungent.  The  Bengal  tobacco, 
of  which  the  sheroots  are  made,  is  one  of  the 
most  mild  in  its  properties.  After  this  is  the 
"West  India  tobacco,  which  affords  the  Havana 
cigars.  Next  is  the  tobacco  of  our  Southern 
States,  and,  lastly,  the  tobacco  raised  in  the  north- 
ern parts  of  the  Union,  which  is  the  most  acri- 
monious and  pungent  of  all. 

Chemists  have  extracted  from  tobacco  a  color- 
less liquid  alkaloid,  which  they  have  called  Nico 
tine.  It  is  acrid  to  the  taste  and  smell,  forms 


352  HISTORY   AND   USE   OF   TOBACCO. 

neutral  compounds  with  acids,  and  is  intensely 
poisonous  in  minute  quantities.  Nicotianine, 
another  product,  is  a  concrete  volatile  oil,  like 
camphor,  and  resembles  tobacco  in  its  proper- 
ties. 

Among  the  substances  used  by  Sir  Benjamin 
Brodie  in  his  experiments  on  vegetable  poisons, 
was  an  empyreumatic  oil  of  tobacco,  prepared  by 
Mr.  Brande  by  distilling  the  leaves  of  tobacco  in 
a  heat  above  that  of  boiling  water.  A  quantity 
of  watery  fluid  came  over,  on  the  surface  of 
which  was  a  film  of  unctuous  substance,  which 
he  calls  the  empyreumatic  oil.  Mr.  Brodie  found 
that  two  drops  of  this  oil  applied  to  the  tongue 
of  a  young  cat,  with  an  interval  of  fifteen  minutes, 
occasioned  death.  A  single  drop,  suspended  in 
an  ounce  of  water  and  injected  into  the  rectum 
of  a  cat,  produced  death  in  about  five  minutes. 
One  drop,  suspended  in  an  ounce  and  a  half  of 
mucilage  and  thrown  into  the  rectum  of  a  dog, 
produced  violent  symptoms,  and  a  repetition  of 
the  experiment  killed  him. 

Tobacco  has  been  used  both  as  a  luxury  and 
prophylactic,  and  as  a  medicine.  In  the  former 
cases  it  has  not  been  taken  internally,  but  only 


HISTOEY   AND   USE   OF   TOBACCO.  353 

kept  in  contact  with  absorbing  surfaces.  It  is 
well  known  that  to  the  mouth  it  is  applied  in 
substance  and  in  smoke,  and  to  the  nose  in  the 
form  of  powder.  The  opinion,  which  at  one  time 
prevailed,  of  its  power  to  prolong  life  and  to 
secure  immunity  from  diseases,  is  now  pretty 
fully  abandoned.  It  has  no  prophylactic  reputa- 
tion, except  as  a  preservative  for  the  teeth,  and  in 
some  degree  as  a  protection  against  the  contagion 
of  epidemics.  In  both  these  cases  it  has  acquired 
a  certain  degree  of  confidence,  though  it  is  prob- 
ably inferior  to  many  other  substances  for  both 
these  purposes. 

As  to  its  effects  upon  longevity,  the  great 
frequency  of  its  use,  and  the  facts  and  observa- 
tions of  Sir  John  Sinclair,  render  it  improbable 
that,  when  moderately  taken,  it  has  much  influ- 
ence in  wearing  out  the  constitution,  or  abridg- 
ing the  usual  period  of  life.  But,  like  all  other 
narcotics,  its  excessive  use  or  abuse  must  impair 
the  health  and  engender  disease.  Of  the  differ- 
ent modes  of  using  tobacco,  it  is  probable  that 
smoking  is  the  most  injurious,  and  the  most 
capable  of  abuse,  since  in  this  process  the  active 
principles  of  the  tobacco  are  volatilized  with  the 
30* 


354  HISTORY   AM)    USE   OF   TOBACCO. 

smoke,  and  are  extensively  applied  to  the  lungs 
as  well  as  the  mouth  and  nose  and  fauces. 

As  a  medicine,  this  plant  has  been  employed 
in  a  variety  of  ways  for  the  alleviation  and  cure 
of  diseases.  Externally  it  has  been  applied  with 
benefit  in  tinea  capitis,  and  in  some  complaints 
occasioned  by  the  presence  of  insects.  In  the 
form  of  a  cataplasm  applied  to  the  pit  of  the 
stomach  it  occasions  severe  vomiting.  The  pros- 
tration of  strength  and  other  distressing  symp- 
toms which  attend  this  application  must  prevent 
its  general  employment.  Still  it  may  be  remem- 
bered as  an  auxiliary  in  some  cases  where  other 
emetics  have  failed  to  operate.  A  surgeon  in 
the  United  States  Army  informed  me  that  the 
soldiers  had  an  expedient  to  exempt  them- 
selves from  duty,  by  wearing  a  piece  of  to- 
bacco under  each  armpit,  until  the  most  alarm- 
ing symptoms  of  real  illness  appeared  in  the 
whole  system. 

Dr.  James  Currie  has  recorded  a  case  of  epi- 
lepsy cured  by  the  external  use  of  tobacco.  A 
cataplasm  was  applied  to  the  stomach  for  several 
days,  about  half  an  hour  before  the  expected 
return  of  the  paroxysm.  A  violent  impression 


HISTORY   AND   USE   OF   TOBACCO.  355 

was  produced  each  time  upon  the  system,  the 
paroxysm  prevented,  and  the  diseased  associa- 
tion apparently  broken  up.  Two  cases  of  obsti- 
nate and  dangerous  intermittent  were  intercepted 
in  the  same  manner  by  a  decoction  of  half  a 
drachm  of  tobacco  in  four  ounces  of  water, 
thrown  up  as  an  enema,  a  short  period  before 
the  time  of  the  expected  paroxysm. 

The  tobacco  enema  was  formerly  recommended 
in  colic,  nephritic  complaints,  &c.  In  later  years 
it  has  been  extensively  employed  in  aiding  the 
reduction  of  strangulated  hernia.  But  since  the 
introduction  of  ether  and  chloroform  in  the  treat- 
ment of  this  disease,  the  use  of  tobacco  has  been 
little  resorted  to. 

When  the  infusion  is  not  used,  an  injection  of 
tobacco-smoke  into  the  rectum  frequently  pro- 
duces the  same  consequences.  The  smoke  may 
be  made  to  penetrate  further  than  any  liquid, 
and  it  is  equally  efficacious,  from  the  activity 
of  the  volatile  parts.  It  was  formerly  much 
used  in  the  restoration  of  persons  apparently 
dead  from  drowning,  but  of  late  years  it  has 
gone  more  into  disuse.  From  the  sedative  effect 
of  tobacco,  the  tendency  to  syncope  and  the 


356  HISTORY  AND   USE   OF  TOBACCO. 

great  prostration  of  strength  which  it  occasions 
in  ordinary  cases,  it  is  probable  that  its  employ- 
ment, in  cases  of  asphyxia  from  drowning,  must 
assist  in  extinguishing  rather  than  in  rekindling 
the  spark  of  life. 

Tobacco  has  been  employed  with  some  success 
in  the  locked  jaw,  both  of  warm  and  cold  climates, 
by  enemas  of  the  infusion  and  of  the  smoke. 
These  applications  generally  produce  syncope 
and  deathlike  sickness  in  the  patient,  but,  by 
prudent  management  of  them,  the  disease  has 
sometimes  been  overcome. 

This  powerful  medicine  is  reported  to  have 
been  also  employed  with  some  palliative  effect 
in  hydrophobia,  and  certain  other  spasmodic 
diseases.  Its  internal  use,  however,  requires 
great  caution,  since  patients  have  in  various 
instances  been  destroyed  by  improper  quanti- 
ties, administered  by  the  hands  of  the  unskilful 
or  unwary.  Notwithstanding  the  common  use 
and  extensive  consumption  of  tobacco,  in  its 
various  forms,  it  must  unquestionably  be  ranked 
among  narcotic  poisons  of  the  most  active  class. 
The  great  prostration  of  strength,  excessive 
giddiness,  fainting,  and  violent  affections  of 


HISTORY   AND   USE   OF  TOBACCO.  357 

the  alimentary  canal,  which  often  attend  its 
internal  use,  make  it  proper  that  so  potent  a 
drug  should  be  resorted  to,  by  medical  men, 
only  in  restricted  doses,  and  on  occasions  of 
magnitude. 


ON    THE 


EAELY   HISTOBY   OP   MEDICINE, 


[From  a  Review  of  Miller's  Disquisitions  on  the  History  of  Medicine,  published  in  the 
New  England  Journal  of  Medicine  and  Surgery,  April,  1812.] 

IT  is  commonly  understood  that  the  history  of 
medicine  has  already  been  traced  with  sufficient 
accuracy  in  all  ages  and  countries  where  author- 
ities for  its  elucidation  are  extant.  The  labors 
of  Le  Clerc,  Friend,  Haller  and  Cabanis,  seem  to 
have  left  very  little  to  be  wished  in  this  depart 
ment  of  science.  But,  although  a  general  history 
of  medicine  is  by  no  means  a  desideratum  at  the 
present  day,  yet  there  are  undoubtedly  parts  of 
it  which  are  still  susceptible  of  correction  or 
enlargement.  Dr.  Edward  Miller,  the  author  of 
the  present  disquisitions,  apprises  us  that  he  has 
been  induced  to  attempt  them,  partly  from  some 
singular  traits  which  he  thought  he  had  discov- 


EAELY   HISTORY   OF  MEDICINE.  359 

ered  in  the  medicine  of  the  early  Greeks,  and 
partly  from  the  extraordinary  advancement  made 
of  late  years  in  Sanscrit  literature.  By  means 
of  this  last  we  are  informed  that,  long  previous 
to  its  introduction  into  Europe,  the  science  of 
healing  had  made  very  considerable  progress  in 
Hindostan ;  yet  to  commemorate  its  details,  or 
appreciate  its  merits,  has  never  yet  been  the  task 
of  any  historian  in  medicine.  This  new  field  of 
research  Professor  Miller  has  attempted  to  cul- 
tivate, and  the  fruits  of  his  oriental  inquiries 
are  to  constitute  a  second  volume  of  Disquisi- 
tions. In  the  mean  time,  the  present  volume, 
containing  general  archgeological  remarks,  with 
speculations  on  the  primitive  physic  of  Greece 
and  Egypt,  is  submitted  to  the  ordeal  of  the 
public. 

It  must  be  exceedingly  obvious  that,  prior  to 
the  introduction  of  letters,  no  very  definite  in- 
formation can  be  expected  with  regard  to  the 
state  of  medical  practice  in  any  country.  If  the 
traditionary  account  of  the  most  important  and 
notorious  events,  such  as  battles  and  sieges,  the 
rise  and  fall  of  heroes  and  of  empires,  is  involved 
in  necessary  uncertainty  ;  we  cannot  expect  that 


360  OS   THE  EARLY 

a  complex  science,  closely  interwoven  in  early 
ages  with  mystery  and  superstition,  should  reach 
us  in  a  state  capable  of  affording  much  satisfac- 
tion. The  few  traditions  handed  down  to  us 
from  the  primitive  ages  afford  matter  for  specu- 
lation to  the  curious,  but  yield  no  certainty  to 
the  accurate. 

Dr.  Miller,  seemingly  aware  of  the  difficulties 
attendant  on  this  part  of  his  subject,  has  thought 
it  proper  to  commence  the  present  undertaking 
with  a  sort  of  history  d  priori,  or  presumptive 
history,  of  medicine  in  its  primeval  state.  He 
begins  with  stating  the  progress  of  observation 
and  reasoning,  which  would  naturally  be  made 
by  the  early  and  rude  nations,  in  regard  to  the 
phenomena  of  life,  health,  disease  and  death.  He 
details  the  manner  in  which  a  gradual  acquaint- 
ance would  be  formed  with  the  nutritious,  medi- 
cal and  deleterious  effects  of  the  various  produc- 
tions of  nature ;  and  from  hence  assigns  to  the 
Materia  Medica  the  supreme  honors  of  antiquity. 
Afterwards  comes  the  knowledge  of  practical 
physic,  of  anatomy  and  of  surgery,  in  propor- 
tion as  men  became  habituated  to  watch  the 
progress  and  cure  of  diseases,  to  butcher  and 


HISTOBY   OF   MEDICINE.  361 

dissect  brute  animals,  to  sacrifice,  eat,  or  em- 
balm their  own  species,  and  to  inflict  or  remedy 
the  wounds  and  injuries  occasioned  in  war  or 
elsewhere. 

After  this  we  are  presented  with  an  interest- 
ing account  of  that  tract  of  territory,  which  we 
have  reason  to  believe  contained  the  earliest 
tribes  of  our  species.  To  this  region,  composed 
chiefly  of  Egypt,  Ethiopia,  Turkey,  Arabia,  Per- 
sia and  India,  Dr.  M.  gives  the  collective  name 
of  the  Primceval  Chersonese*  He  expatiates  on 
the  exuberance  of  its  soil,  the  variety  and  value 
of  its  productions,  its  inducements  for  agricul- 
ture, and  facilities  for  commercial  intercourse. 
He  represents  that  six  races  or  stems  have,  from 
time  immemorial,  occupied  this  ample  and  favored 
portion  of  the  earth's  surface.  These  are  the 
Chinese,  the  Hindus,  the  Tartars,  the  Iranians 
(or  Assyrians),  the  Arabs,  and  lastly  the  Nilotic 
tribes,  or  those  of  Egypt  and  Ethiopia.  Among 
these  he  assigns  an  undoubted  claim  for  priority 
of  civilization  to  three  nations,  the  Hindus,  the 

*  This  application  of  the  term  Chersonese,  we  think,  •  rather 
stretches  its  ancient  signification. 
31 


362  ON  THE  EAELY 

Iranians,  and  the  tribes  inhabiting  the  banks  of 
the  Nile.  The  individual  claims  of  these  three 
he  compromises  by  endeavoring  to  prove,  from 
tradition  and  history,  from  identity  of  language, 
<fec.,  from  conformity  of  religious  and  philosoph- 
ical opinions,  and,  lastly,  from  similitude  of  cor- 
poreal structure,  that  they  were  only  separate 
branches  of  one  and  the  same  individual  family 
or  race  of  men.  In  this  investigation  the  author 
gives  proofs  of  extensive  and  assiduous  research. 

Before  quitting  the  general  subject  of  the 
Primaeval  Chersonese,  we  are  made  minutely 
acquainted  with  its  natural  productions,  or  those 
articles  which  must  have  constituted  the  earliest 
food  and  medicine  of  man. 

We  now  come  to  the  particular  history  of  med- 
icine in  early  Greece,  as  it  existed  during  the 
traditionary  ages.  On  collecting  the  scattered 
rays  of  information  respecting  this  period,  chiefly 
from  the  poets,  our  author  alights  on  a  curious 
circumstance,  which  he  makes  the  basis  of  this 
chapter,  viz.,  "  That,  for  its  first  discoveries 
and  improvements,  medicine  in  Greece  appears 
indebted  almost  wholly  to  two  orders  of  men, 


HISTORY   OF  MEDICDTE.  363 

from  whom  such  benefit  was  not  likely  to  be 
derived,  viz. : 

"  1.  The  chiefs  or  sovereigns  of  its  different 
small  communities. 

"  2.    The  priests  or  ministers  of  religion." 

Upon  this  ground  the  author  proceeds  to  give 
us  two  dissertations  on  the  heroic  and  the  priest- 
ly medicine  of  Greece  ;  —  and,  first,  of  "  heroic 
medicine." 

On  this  subject  we  are  told  that  scarcely  a 
royal  or  distinguished  personage,  during  the  tra- 
ditionary period,  can  be  named,  to  whom  some 
degree  of  medical  skill  has  not  been  accorded. 
The  ascription  of  this  honor  is  traced  to  several 
causes,  such  as  the  obscurity  which  hangs  over 
the  beginning  of  all  arts ;  the  veneration  which 
savage  tribes  entertain  for  the  character  of  their 
leaders  ;  and  the  policy  which  would  lead  these 
chiefs  to  maintain  their  ascendency  by  the  dis- 
play of  every  species  of  personal  merit  or  skill, 
that  of  medicine  being  not  the  least  imposing. 
The  practice  of  these  heroic  physicians,  which 
the  author  believes  to  have  been  chiefly  surgical, 
is  illustrated  by  various  accounts  of  the  thera- 
peutic exploits  performed  by  several  individuals. 


364  ON   THE  EARLY 

These  are  Chiron,  Esculapius,  Machaon,  Podali- 
rius,  Achilles,  Teucer,  &c.  &c.  &c.  The  claims 
for  medical  distinction  are,  indeed,  so  numerous 
that  they  may  be  said  to  amount  to  no  distinc- 
tion at  all,  since  every  man  whose  name  has 
been  handed  down  to  us  as  holding  a  rank  in 
a  tolerable  degree  above  the  vulgar,  would  seem 
entitled  to  enrolment  among  the  faculty.  Chi- 
ron the  Centaur  is  stated  to  have  been  precep- 
tor to  nearly  all  the  heroes  who  figured  in  the 
Argonautic  and  Trojan  expeditions.  Now,  as 
Chiron  was  one  of  those  universal  geniuses,  who 
was  competent  to  exercise  the  arduous  and  mul- 
tiform functions  of  warrior  and  necromancer,  of 
horse-breaker,  musician  and  doctor,  it  must  be 
supposed  that  those  who  received  the  supreme 
honors  of  his  school  were  not  ushered  into  the 
world  without  a  smattering  of  these  various  ac- 
complishments. Hence  the  crew  of  the  Argo 
might,  on  emergency,  be  considered  a  crew  of 
the  faculty  ;  and  the  council  of  warriors  in 
Agamemnon's  camp  required  only  a  change  of 
occasion  to  resolve  them  into  a  jury  of  doctors. 

We  have  already  intimated  that  any  accounts 
now  extant  respecting  the  medicine  of  the  early 


HISTORY   OF   MEDICINE.  365 

Greeks  must  be  extremely  unsatisfactory.  We 
may  now  add,  that,  from  the  few  authorities  we 
have,  it  may  be  doubted  whether  any  proficiency 
in  medicine  was  ever  made  among  them,  beyond 
what  a  rude  individual  would  naturally  attain  in 
the  science  of  self-preservation.  The  boasted 
achievements  performed  by  their  distinguished 
personages  apparently  consisted  in  some  trifling 
and  obvious  operations,  or  else  in  such  exag- 
gerated and  miraculous  performances  as  distance 
all  possibility  of  belief.  The  heroic  or  surgical 
practice  among  them  was  confined  chiefly  to  the 
extraction  of  weapons  and  the  dressing  of 
wounds.  The  highest  praise  which  Homer  has 
bestowed  on  the  medical  or  surgical  profession 
is  contained  in  the  following  lines : 

'/ijTgo;  yaQ  '«»'»;(>  noM.tov,  'arra^iof  aP.Acor, 

'J«S  t'  txTauvfir,  'tni  T*  J;/ri«  tpanuay.a  naoativ, — 

which  amount  to  simply  this, —  that  "one  doc- 
tor is  worth  a  host  of  other  men,  to  cut  out 
arrows,  and  apply  mild  dressings."  And,  indeed, 
whenever  he  tells  us  of  such  a  man  being  actu- 
ally engaged  in  practice,  it  is  commonly  in  one 
or  the  other  of  the  above  processes.  Now  it 
31* 


366  ON  THE  EAELY 

could  require  no  great  depth  of  intellect  to  dis- 
cover, that  if  a  barbed  arrow  stuck  in  the  flesh, 
it  could  most  easily  be  removed  by  excision,  and 
that  if  a  wound  became  dry  and  painful  from 
exposure  to  the  air,  it  might  be  made  more 
comfortable  by  covering  it  with  emollient  appli- 
cations. 

But,  with  such  humble  and  obvious  operations 
as  these,  the  ancient  physicians  could  not  have 
sustained  their  elevated  rank  in  society,  and  sub- 
stantiated their  claims  upon  immortality.  It 
became  necessary,  in  order  to  secure  complete 
ascendency  over  the  public  mind,  that  they 
should  profess  an  intercourse  with  the  gods,  a 
knowledge  of  mysterious  charms  and  incanta- 
tions, and  other  special  gifts  peculiar  to  jug- 
glers in  all  nations  since  their  time.  Very  sur- 
prising stories  are  told  of  Melampus,  Polyidus, 
and  Chiron.  These,  however,  are  small  when 
compared  with  the  feats  of  Esculapius,  the  prince 
of  physicians,  and  the  deified  inventor  of  medi- 
cine. Esculapius,  in  addition  to  many  other 
astonishing  powers,  was  gifted  with  a  very  re- 
markable faculty,  peculiar  to  himself,  of  raising 
at  pleasure  the  dead  to  life.  Not  less  than  six 


HISTOKY   OF   MEDICINE.  367 

or  seven  instances  are  on  record  of  distinguished 
corpses  that  were  benefited  by  the  exertion  of 
this  happy  talent.  It  is  impossible  to  say  how 
far  the  bounds  of  science  might  have  been  en- 
larged by  so  mighty  a  genius,  had  not  Pluto 
taken  alarm  at  his  progress,  and  presented  a 
memorial  to  Jupiter,  humbly  showing,  that  if  a 
stop  was  not  put  to  the  career  of  this  officious 
mortal,  people  would  soon  cease  to  die,  and  hell 
would  become  a  desert  ;  whereupon  Jupiter 
interposed,  and  killed  the  wonder-working  doctor 
with  his  thunderbolts. 

There  is  reason  to  believe,  from  what  has  been 
said,  that  the  cures  effected  by  these  medical 
worthies  were  either  inconsiderable  and  real,  or 
else  preternatural  and  counterfeited.  We  have 
additional  ground  for  this  belief,  on  finding  that 
frequently,  when  emergencies  occurred  opening 
a  fine  field  for  medical  practice,  the  champions 
of  physic  were  totally  idle  or  inefficient.  When 
a  pestilence  broke  out  among  the  Greeks  at  the 
Trojan  war,  we  find  them,  with  all  their  heroic 
and  priestly  medicine,  resorting,  not  to  their 
drugs  and  preparations,  not  to  any  regular  sys- 
tem of  practice,  but  simply  to  superstitious 


368  ON  THE  EARLY 

prayers,  rites  and  atonements.  The  Argonauts, 
with  Esculapius  at  their  head,  required  the  aid 
of  a  sorceress,  before  they  could  administer  an 
opiate  to  the  dragon  that  watched  their  fleece. 
Chiron  died  of  a  wound  or  ulcer  in  the  leg,  and 
Achilles  of  one  in  the  heel.  Such  disasters  as 
these  last  were  not  to  be  expected,  after  what 
Dr.  Miller  tells  us  in  his  account  of  Chiron  :  — 
"  So  celebrated  was  he  in  tradition  for  the  cure 
of  ulcers,  as  we  are  informed  by  Galen,  that 
when  a  sore  was  obstinate  and  could  not  be 
healed  up,  it  was  customary  in  later  times  to 
call  it  a  Chironian  ulcer;  intimating,  by  the 
expression,  that  it  was  an  ailment  of  such 
malignity  as  to  baffle  the  skill  even  of  Chiron 
himself." 

Now,  we  conceive,  it  was  no  compliment  to 
the  Centaur  to  name  only  incurables  after  him. 
We  also  conceive  that,  between  Galen  and  Dr. 
Miller,  the  origin  of  the  term  Chironian  ulcer 
may  have  been  mistaken,  and  that  it  may  be  de- 
rived, not  from  the  skill  of  Chiron  in  curing 
malignant  ulcers,  but  from  the  circumstance  of 
his  having  languished  and  died  under  a  malig- 
nant ulcer.  Galen  informs  us,  on  this  subject, 


HISTORY   OF   MEDICINE.  369 

that  of  the  phagedaena,  or  eating  ulcer,  there  were 
different  species,  called  the  Chironian  and  Tele- 
phian :  "  Harum  species  qusedam  sunt,  -qua3 
Chironia  et  Telephia  dicuntur."  In  another  place 
he  tells  us  that  the  Telephian  ulcer  was  so  called 
from  Telephus,  who  was  afflicted  with  it.  Now 
the  case  of  Chiron  was  not  dissimilar  to  that 
of  Telephus,  as  both  their  maladies  were  oc- 
casioned by  the  wound  of  a  spear,  only  Tele- 
phus got  well,  whereas  Chiron,  after  languish- 
ing with  his  lame  leg  for  nine  days,  either  died/ 
or  was  made  into  a  constellation ;  for  all  which 
the  reader  may  consult  Ovid.  Fastorum,  V.  379 
-414. 

Machaon,  the  son  of  Esculapius,  when  wounded 
at  the  siege  of  Troy,  retired  with  Nestor  to  his 
tent,  where  they  took  from  the  hands  of  a 
woman  a  farrago  of  onions,  cheese,  meal,  honey 
and  wine.  From  Pope's  translation  of  this 
account  in  the  Iliad,  which  Dr.  M.  has  quoted,  wo 
are  led  to  suppose  that  this  potion  was  a  pre- 
scription of  the  physician  himself  for  his  own 
case.  "Witness  the  following  lines  : 

"  The  draught  prescribed  fair  Hecamede  prepares." 


370  ON  THE   EARLY 

Aiid  again, 

"  This/or  the  wounded  prince  the  dame  prepares." 

Unfortunately,  however,  there  is  no  sort  of 
authority  in  the  original  for  the  above  expres- 
sions, and  it  appears  that  Hecamede  prepared 
the  draught,  probably  of  her  own  invention,  to 
treat  her  master  Nestor,  as  well  as  his  guest  Ma- 
chaon,  and  this,  too,  for  the  sole  purpose  of 
assuaging  their  thirst. 

Toifli  <5«  Tti'/t  xvxttta  'tvnlvxotuos  'Exaui'jiq.     II.  ')..  G23. 
Tia  $'  intl  vvv  nirovr'  atpiryr  TTolvxayaia  Sityav.*   641. 

It  is  a  little  remarkable  that  the  learned  pro- 
fessor should  copy  out  the  whole  Greek  passage 
for  his  book,  and  overlook  such  words  as  ronr/, 
crQv'tf,  aq>i  and  TW  ;  or  imagine  them  to  be  meant 
for  Machaon  individually.  We  are  much  in- 
clined to  suspect  that  he  placed  undue  reliance 
on  the  translation,  when  we  find  him  leaving  off 
his  Greek  in  the  middle  of  a  sentence,  and  ob- 
serving that  "It  might  be  difficult  in  English 
poetry  to  discover  a  translation  more  distin- 

*  The  translations  of  this  passage  by  Cowper  and  Dacier  are 
correct.     Chapman  has  the  same  inaccuracy  with  Pope. 


HISTORY   OF  MEDICINE.  371 

guished  for  a  happy  mixture  of  precision  and  ele- 
gance, than  the  above  version  of  Pope." 

One  more  of  these  worthies,  and  then  we  have 
done  with  "  heroic  medicine."  We  presume  that 
the  name  of  Achilles  will  not  yet  descend  to  ob- 
livion, even  though  our  author  should  fail  in  his 
attempts  to  dub  him  also  a  doctor  of  medicine. 
Nevertheless  Achilles,  it  seems,  was  a  pupil  of 
Clu'ron.  He  cured  the  wound  of  Telephus  with 
the  rust  of  his  spear ;  and  the  plant  Achillaea,  or 
yarrow,  had  the  honor  to  be  named  after  him. 
But  it  ought  not  to  be  forgotten  that  the  circum- 
stance of  his  pupilage  was  common  to  most  of 
the  preeminent  heroes  of  his  time,  and  that  in 
the  cure  of  Telephus  he  had  scarcely  any  merit. 
Telephus  consulted  the  oracle,  and  was  told  that 
his  wound  could  only  be  healed  by  the  same 
spear  which  had  occasioned  it.  Accordingly  he 
applied  to  Achilles,  whose  spear  had  done  the 
mischief,  and  requested  his  medical  assistance. 
Achilles  at  first  refused,  saying  that  he  was  no 
physician  ;  but  afterwards  was  prevailed  on  to 
scrape  the  rust  of  his  spear  into  the  wound, 
which,  in  due  time,  got  well.  With  regard  to 
the  plant  Achillaea,  we  presume  its  name  has  as 


372  ON   THE   EARLY 

• 

much  to  do  with  medicine  as  that  of  the  plant 
Jeffersonia. 

"We  now  come  to  consider  the  second  depart- 
ment which  Dr.  Miller  has  made  in  the  physic  of 
Greece,  namely,  his  Priestly  medicine.  As  he 
has  shown  that  the  medicine  of  heroes  was  chiefly 
surgical,  he  now  makes  it  equally  clear  that  that 
of  priests  and  conjurers  was  mere  "practical 
physic."  For  this  he  gives  us  all  the  presump- 
tive evidence  which  can*  arise  from  the  natural 
ascendency  of  priests  and  wizards  over  the  pub- 
lic mind,  and  from  the  analogy  of  customs  in  all 
the  barbarous  nations  in  the  world.  He  gives 
us,  however,  only  two  instances  of  priest-phy- 
sicians in  Greece,  namely,.  Melampus  and  Or- 
pheus ;  of  whom  Melampus  appears  to  us  to  have 
been  only  a  fortune-hunter,  who  cured  the  daugh- 
ters of  Prcetus  of  real  or  pretended  madness, 
that  he  might  gain  the  hand  of  one  of  his  patients, 
together  with  her  kingdom,  in  marriage ;  while 
with  regard  to  Orpheus,  there  is  very  little 
authority  for  his  having  practised  physic  in  any 
particular  instance,  and  his  high  reputation  is 
sufficiently  supported  by  the  established  fact,  that 

'•  He  played  so  well,  he  moved  Old  Nick." 


HISTOEY   OF   MEDICINE.  373 

On  considerations  like  the  foregoing  we  are 
disposed  to  ascribe  to  the  ancient  Greeks  the 
credit  of  very  little  real  proficiency  in  the  art  of 
healing.  From  similar  motives  Ave  doubt  the 
correctness  of  Dr.  Miller's  belief,  that  Greece 
was  indebted  for  its  first  discoveries  and  im- 
provements in  medicine  solely  to  two  classes  of 
men,  namely,  the  chiefs  or  sovereigns,  and  the 
priests  or  ministers  of  religion.  Unwilling,  how- 
ever, to-  interfere  with  the  doctor's  ardor  for 
classification,  we  only  suggest,  for  a  second 
edition  of  his  work,  the  propriety  of  adding  a 
new  class  or  department  in  primitive  physic,  to 
be  caUed  the  department  of  old  women,  or  of 
female  medicine.  These  early  practitioners  of 
physic,  we  think,  he  has  treated  with  unmerited 
neglect :  for  we  will  engage,  where  he  pro- 
duces one  instance  in  Greece  of  a  priest  skilled 
in  medicine,  that  we  wih1  furnish  two  of  females 
possessing  the  same  accomplishment.  It  is  suf- 
ficient now  to  mention  only  the  names  of  Circe, 
Medea,  Angitia,  Agamede,  Helen  and  (Enone!* 

*  "  In  these  early  ages  all  the  knowledge  of  the  tribe  formed  a 
common  stock  ;  and  their  imperfect  arts  might  be  exercised  by  all 

32 


374  ON   THE   EARLY 

The  last  portion  of  our  author's  work  embraces 
the  history  of  medicine  in  Egypt  and  the  East ; 
and  on  this  subject  our  limits  compel  us  to  be 
more  brief.  The  advantages  possessed  by  the 
Eastern  countries  over  European  Greece  for  the 
early  cultivation  of  science,  are  said  to  have 
been  the  coalition  of  their  inhabitants  into  large 
and  mighty  empires,  instead  of  petty  states  and 
communities ;  and  also  the  peculiar  nature  of 
their  ecclesiastical  institutions,  in  which  an  he- 
reditary priesthood  was  placed  in  possession  of 
all  the  facilities  and  inducements  for  scientific 
speculation.  The  invention  of  letters,  or  alpha- 
betic characters,  was  among  them  an  early  aux- 
iliary to  the  cultivation  of  the  sciences,  and 
medicine  was  not  the  last  to  profit  by  so  signal 
an  advantage.  Some  of  the  earliest  lettered 
productions  contained  copious  treatises  on  the 
healing  art  as  an  integrant  portion  of  their  con- 
tents. 

The  very  ancient  and  celebrated  personage 
Thoth,  or,  as  he  is  called  by  Dr.  Miller,  Tot,  and 

those  who  were  endowed  with  a  certain  portion  of  intelligence. 
Medicine,  therefore,  existed  before  there  were  any  regular  physi- 
cians." —  Cabanis's  Revolutions  of  Med.  Science. 


HISTORY   OF   MEDICINE.  375 

who  is  the  same  with  Hermes,  or  Mercury  of  the 
Greeks,  seems  to  have  been  the  founder  of 
medicine  in  Egypt.  His  writings,  afterwards 
held  sacred,  were  divided  into  forty-two  books, 
six  of  which  treated  of  medical  subjects,  namely, 
one  of  anatomy,  one  of  diseases,  one  of  instru- 
ments, one  of  medicaments,  one  of  disorders  of 
the  eyes,  and  one  of  diseases  of  women.  While 
the  higher  orders  of  Egyptian  priesthood  were 
employed  in  the  study  and  execution  of  religious 
and  philosophical  offices  contained  in  the  former 
books,  a  second  or  inferior  class  were  busied  in 
the  study  and  practice  of  healing.  The  Pasto- 
phori.  for  so  the  cultivators  of  physic  were  called, 
were  bound  to  make  themselves  intimately  ac- 
quainted with  the  medical  scriptures  of  Thoth, 
and  so  long  as  their  practice  was  strictly  con- 
formable to  these,  no  blame  was  incurred  by 
them.  On  the  contrary,  if  any  practitioner  ven- 
tured to  deviate  in  the  least  from  these  sacred 
rules,  he  became  responsible  with  his  own  life  for 
the  safety  of  his  patient.  This  circumstance 
must  have  furnished  a  powerful  check  to  im- 
provement, and  kept  the  science  of  medicine  long 
in  a  state  altogether  stationary. 


376  ON   THE   EARLY 

Of  the  other  peculiarities  in  Egyptian  prac- 
tice, the  following  are  among  the  most  remark- 
able :  The  art  was  made  altogether  hereditary, 
so  that  "  he  who  was  born  a  physician  was  pro- 
hibited equally  by  Heaven  and  by  law  from 
abandoning  the  occupation  of  his  ancestors." 
The  profession  was  also  subdivided  into  minute 
departments,  so  that  each  particular  disease  had 
a  separate  healer.  Some  took  charge  of  dis- 
orders of  the  eyes,  some  of  the  head,  some  of 
the  teeth,  some  of  the  abdomen,  <fcc.  The  vast 
number  of  individuals  who  were  engaged  in  some 
branch  of  medical  practice  led  to  the  assertion  of 
Homer  and  Herodotus,  that  in  Egypt  every  man 
met  with  was  a  physician. 

What  were  the  particular  modes  of  practice 
enjoined  by  Thoth  it  is  impossible  now  to  know, 
for  the  books  of  the  Pastophori  have  long  since 
been  lost.  Dr.  Miller,  however,  has  industri- 
ously attempted  to  glean  whatever  authorities 
were  afforded  respecting  them,  from  their  suc- 
cessors in  art  and  science,  the  Greeks.  He  has 
told  us  that  the  Pastophori,  and  even  the  kings, 
were  wont  to  immolate  and  dissect  beasts  and 
human  victims,  but  with  what  proficiency  in 


HISTOKY   OF  MEDICINE.  377 

anatomy  it  is  not  known.  In  the  science  of 
diseases  they  appear  to  have  had  some  idea 
of  critical  days,  to  have  divided  disorders  into 
acute  and  chronic,  and  to  have  ascribed  their 
pestilential  distempers  to  a  morbific  principle  in 
the  air.  In  the  Materia  Medica,  they  seem  to 
have  been  acquainted  with  many  efficacious 
articles,  together  with  their  most  useful  forms 
of  composition. 

Having  now  run  through  the  contents  of  this 
volume,  we  would  observe  that,  in  general,  it  is 
far  from  being  an  uninteresting  production.  The 
extent  of  the  author's  researches,  and  the  inge- 
nuity of  his  deductions,  will  afford  some  novelty 
and  instruction  to  most  readers.  His  predomi- 
nant fault  is  a  disposition  to  annex  an  undue 
consequence  to  circumstances  which  are  doubt- 
ful or  unimportant.  We  think  he  might  profit 
by  the  observation  of  Cabanis,  that,  in  a  subject 
where  materials  to  compensate  inquiry  are  want- 
ing, "  the  friends  of  truth  should  not  lose  their 
time  in  forming  vain  conjectures,  however  learned 
they  may  happen  to  be." 
32* 


ADDEESS 

DELIVERED     BEFORE 

THE  AMERICAN  ACADEMY  OF  ARTS 
AND    SCIENCES, 

AT  THE  OPENING  OF  THEIR  COURSE   OF  LECTURES,  OCTOBER  27,  1852. 


At  a  meeting  of  the  American  Academy  of  Arts  and  Sciences, 
June  22,  1852,  — 

Mr.  Agassiz,  in  behalf  of  the  committee  appointed  to  consider 
the  best  means  of  increasing  the  Academy's  publication  fund, 
reported,  —  that  the  committee  were  unanimous  in  recommending 
that  a  course  of  public  lectures  of  a  popular  character  be  given  by 
Fellows  of  the  Academy  during  the  ensuing  winter ;  that  the  Pres- 
ident be  requested  to  commence  the  course  by  an  Address  setting 
forth  the  objects  and  aim  of  the  course  ;  and  that  each  section  of 
the  Academy  appoint  one  of  its  number  to  deliver  one  lecture 
upon  some  special  subject  belonging  to,  and  prominent  in,  the 
section's  sphere  of  research. 

IT  has  been  a  serious  question  whether,  amid 
the  general  sadness  which  hangs  as  a  cloud  over 
our  city,  which  has  seemed  to  check  the  ordi- 


ACADEMY   OP  ARTS  AND   SCIENCES.  379 

nary  current  of  affairs,  and  to  darken  the  very 
atmosphere  of  social  intercourse,*  the  prear- 
ranged exercises  of  this  place  should  not  be 
suspended  in  solemn  and  silent  respect  to  the 
unusual  occasion.  But  \ve  are  bound  by  circum- 
stances to  perform  that  which  at  this  time  we 
would  not  have  wished  to  do.  And  leaving  to 
the  public  voice  the  expression  of  that  general 
emotion,  to  which  no  limited  occasion  can  afford 
utterance,  we  shall  proceed  in  the  attempt  to 
execute  the  more  humble  duty  that  has  been  set 
before  us. 

I  ain  instructed,  in  behalf  of  the  American 
Academy  of  Arts  and  Sciences,  to  report  to  you 
this  evening  on  the  character  and  condition  of 
that  institution,  and  the  objects  of  the  present 
course  of  lectures.  If  it  were  possible  that  a 
society  which  has  existed  in  your  midst  for  two 
or  three  generations,  and  which  from  time  to 
time  has  numbered  among  its  members  many  of 
the  most  enlightened  and  valuable  of  our  citi- 
zens, could  be  in  any  measure  unknown,  I  might 
safely  rely  on  the  more  gifted  laborers,  who  are 

*  The  death  of  Daniel  Webster. 


380  ADDRESS   BEFORE    THE   AMERICAN 

to  follow  me  in  this  field,  for  the  vindication  of 
its  character  and  name.  And  if  the  present  occu- 
pation of  this  lecture-room  were  a  question  of 
doubtful  propriety,  I  might  briefly  say  that  the 
Academy  needs,  nay,  more,  that  it  deserves  your 
countenance  and  support,  and  that  this  is  the 
place  and  the  manner  in  which  your  kind  regards 
have  been  solicited  towards  the  encouragement 
of  its  labors.  But  as  the  quiet  operations  of  Sci- 
ence have  not  that  wide-spread  notoriety  which 
attends  the  more  absorbing  questions  of  peace 
and  war,  of  property  and  privilege,  of  safety  and 
of  danger,  there  is  reason  for  attempting  a  more 
detailed  consideration  of  the  objects  and  results 
of  our  Academic  Incorporation. 

Academies  in  the  higher  use  of  the  term,  phi- 
losophical and  learned  societies,  exist  and  have 
long  existed  in  every  country  of  civilized  Europe. 
In  common  with  Colleges  and  Universities,  they 
are  designed  to  cultivate  and  disseminate  scien- 
tific truth;  but  unlike  those  institutions,  the  usual 
province  of  the  modern  Academy  is  to  investi- 
gate rather  than  to  teach ;  to  bring  together  ex- 
perts from  the  various  walks  of  science,  litera- 
ture and  art;  to  accumulate  for  the  benefit  of  the 


ACADEMY   OF  AETS   AND  SCIENCES.  381 

whole  the  researches  and  observations  of  all,  to 
aid  and  to  encourage  the  different  inquirers  on 
their  respective  tracks,  and  to  furnish  vehicles 
for  what  is  true,  and  ordeals  for  what  is  unsettled, 
in  the  progress  of  human  knowledge. 

One  of  the  early  fruits  of  the  restoration  of 
arts  and  letters  in  Italy  was  the  perception  of 
the  great  advantage  attending  the  combination 
of  effort  in  academic  institutions.  In  that  coun- 
try were  the  first  efficient  examples  of  learned 
bodies  cooperating  for  their  common  good,  and 
bringing  their  united  efforts  to  bear  in  the  pro- 
motion of  the  arts  and  sciences.  From  Italy  the 
principle  of  academic  association  spread  to  Eng- 
land, Germany  and  France,  and  in  all  those  coun- 
tries, noble  institutions,  having  their  foundation 
in  the  earnest  quest  of  truth,  and  supported  by 
the  zeal  and  learning  of  the  best  men  of  their 
times,  have  been  sent  down  to  the  present  age, 
marking  their  way  by  many  high  developments 
of  human  intellect,  and  noble  achievements  of 
human  science.  Some  of  them,  which  for  two 
centuries  have  enjoyed  the  sunshine  of  royal  and 
public  patronage,  now  find  themselves  intrenched 
in  ample  halls,  surrounded  by  the  machinery  of 


382  ADDRESS   BEFORE   THE   AMERICAN 

modern  science,  dispensing  rewards  with  princely 
prodigality,  offering  seats,  of  which  the  prospec- 
tive vacancy  fills  with  ambition  the  learned  of 
foreign  countries,  throwing  lustre  on  the  cities 
of  their  respective  establishment,  and  connected 
by  little  resemblance,  save  that  of  etymology, 
with  the  simple  preceding  groves  of  Plato  and 
Arcesilaus. 

Academic  institutions  have  differed  widely 
from  each  other  in  the  object  as  well  as  the 
comprehensiveness  of  their  pursuits.  Not  only 
does  the  history  of  literature  furnish  many  ex- 
amples of  Academies  of  Sciences  and  the  Arts, 
but  there  are  well-known  like  institutions  of 
Belles  Lettres,  of  Language,  of  Inscriptions,  of 
Painting,  Sculpture  and  Architecture,  of  Music, 
of  Antiquities,  and  of  many  subordinate  branches 
of  useful  and  of  elegant  learning.  Of  course,  the 
value  of  membership  in  any  of  these  bodies  has 
depended  on  the  character  of  the  institution  it- 
self, and  the  principles  on  which  it  is  conducted. 
The  Royal  Academy  of  France,  often  known  par 
excellence  as  the  Academy,  not  only  under  its  orig- 
inal name,  but  under  the  subsequent  appellations 
of  National  and  Imperial  Institute,  has,  during  a 


ACADEMY  OF   ARTS   AND   SCIENCES.  383 

long  period  of  years,  sustained  an  almost  -uninter- 
rupted preeminence  in  the  republic  of  letters. 
The  labors  of  this  body  have  cast  a  flood  of  light 
on  modern  science,  and  its  assembled  savans  have 
formed  a  tribunal  from  whose  scientific  sentence 
there  seemed  no  appeal.  Yet,  even  this  institu- 
tion, under  the  occasional  supineness  of  its  mem- 
bers, and  the  influence  of  royal  favoritism,  has 
more  than  once  been  a  mark  for  the  shafts  of  co- 
temporaneous  criticism.  The  poet  Piron,  affect- 
ing  to  define  his  own  humble  position  by  an  epi- 
taph, says,  "  Here  lies  Piron,  who  was  nothing  at 
all,  not  even  an  Academician." 

In  the  year  1779,  in  the  midst  of  the  exhaust- 
ing and  yet  unfinished  contest  of  our  Revolution, 
with  humble  resources,  but  with  confidence  of 
future  promise,  the  American  Academy  of  Arts 
and  Sciences  was  founded  by  an  association  of 
citizens  of  Massachusetts.  The  fathers  of  our 
Commonwealth,  well  aware  that  the  lights  of 
liberty  and  learning  are  jointly  conducive  to  the 
stability  of  free  government,  gave  their  sanction 
and  in  many  cases  their  individual  efforts  to  con- 
struct the  foundation  of  an  ample  edifice.  Among 
the  constellation  of  worthies  enrolled  as  the  first 


384  ADDRESS   BEFORE   THE   AMEEICAN 

members,  we  find  the  names  of  the  two  Adamses, 
of  Bowdoin  and  Gushing,  of  Chauncey  and  Coop- 
er, of  Hancock,  of  Lowell,  of  Sedgwick,  Strong 
and  Sullivan,  and  about  fifty  others,  all  of  them 
names  already  registered  in  the  annals  of  their 
country's  service,  or  distinguished  as  proficients 
in  the  learning  of  their  time. 

The  preface  to  their  first  publication  states 
that  the  Legislature  was  called  on  to  sanction 
the  society  on  a  liberal  and  extensive  plan,  and 
to  establish  it  on  a  firm  basis.  "  And  to  the 
honor  of  our  political  fathers,"  say  they,  "  be  it 
spoken,  that  although  the  country  was  engaged 
in  a  distressing  war,  —  a  war  the  most  important 
to  the  liberties  of  mankind  that  was  ever  under- 
taken by  any  people,  and  which  required  the  ut- 
most attention  of  those  who  were  entrusted  with 
our  public  concerns, — they  immediately  adverted 
to  the  usefulness  of  the  design,  entered  into  its 
spirit,  and  incorporated  a  society  with  ample 
privileges." 

But  the  approval  of  the  Legislature  was  but  a 
small  offset  to  the  difficulties  against  which  the 
new  association  had  to  contend.  "  The  country 
being  young,"  say  they,  "  few  among  us  have 


ACADEMY   OF  ARTS   AND   SCIEIS'CES.  385 

such  affluence  and  leisure  as  to  admit  of  our 
"  applying  much  time  to  the  cultivation  of  the 
sciences."  And  in  another  place,  "  Many  im- 
portant European  discoveries  have  been  in  a 
great  measure  useless  to  this  part  of  the  world, 
in  consequence  of  a  situation  so  remote  from  the 
ancient  seats  of  learning  and  improvement.  And 
of  such  publications  as  have  reached  this  coun- 
try, the  smallness  of  the  number  has  greatly 
limited  their  usefulness,  as  but  few  have  had  the 
opportunity  for  perusing  them." 

Under  such  disadvantages,  so  unlike  the  state 
of  things  now,  well  might  our  courageous  pre- 
decessors solace  and  assure  themselves  by  a  pro- 
spective view  of  the  harvests  they  were  sowing 
for  their  descendants.  "  Settled,"  say  they,  "  in 
an  extensive  country,  bordering  upon  the  ocean, 
and  opened  to  a  free  intercourse  with  all  the  com- 
mercial world, —  a  country  comprehending  sev- 
eral climates  and  a  rich  variety  of  soils,  watered 
and  fertilized  by  multitudes  of  springs  and 
streams,  and  by  many  grand  rivers,  —  the  citizens 
have  great  opportunities  and  advantages  for 
making  useful  experiments  and  improvements, 
whereby  the  interests  and  happiness  of  the  rising 
33 


386  ADDKESS   BEFOEE   THE  AMEKICAN 

empire  may  be  essentially  advanced.  At  the 
same  time  enjoying,  under  a  mild  but  steady  gov- 
ernment, that  freedom  which  excites  and  rewards 
industry  and  gives  a  relish  to  life,  —  that  freedom 
which  is  propitious  to  the  diffusion  of  knowledge, 
which  expands  the  mind  and  engages  it  to  noble 
and  generous  pursuits,  —  they  have  a  stimulus  to 
enterprise  which  the  inhabitants  of  few  other 
countries  can  feel." 

Such  were  the  principles  and  the  auspices 
under  which  was  kindled  the  small,  dim  light  of 
our  Academy.  Although  it  was  not  often  over- 
fed with  fuel,  nor  at  all  times  watched  with  vestal 
vigilance,  it  has  at  least  never  been  suffered  to 
go  wholly  out,  and,  after  glimmering  with  un- 
certain yet  increasing  rays  for  two  thirds  of  a 
century,  it  has  at  length  grown  to  be  an  ac- 
knowledged beacon  in  science,  a  light  to  the 
philosophic  of  our  own  country,  a  western  star 
to  whose  unshadowed  brilliancy  and  true  moni- 
tions the  European  world  now  looks  with  in- 
terest and  respect. 

The  early  labors  of  the  Academy  were  in  keep- 
ing with  its  early  professions.  They  did  not 
trench  deeply  on  fields  appropriated  by  foreign 


ACADEMY   OP   ARTS   AND   SCIENCES.  387 

explorers,  but  rather  turned  their  inquiries  to 
the  capacities  of  their  own  country,  to  the  im- 
provement of  its  practical  advantages  and  the 
knowledge  of  its  natural  history.  With  the  ex- 
ception of  a  few  limited  papers  in  mathematics 

and  astronomy,  the  first  volumes  of  the   Trans- 

0 
actions  are  occupied  with  such  objects  as  the 

cultivation  of  corn  and  the  engrafting  of  trees, 
examination  of  springs  of  water,  and  reports  on 
diseases  of  cattle,  speculations  on  natural  caves, 
recorded  earthquakes  and  conjectured  volcanoes. 
Narratives  are  given  of  the  appearance  of  water- 
spouts, and  of  remarkable  devastations  of  light- 
ning on  trees,  rocks  and  dwelling-houses.  Fossil 
frogs,  "  that  under  the  cold  stone  "  were  believed 
to  have  passed  monotonous  ages  of  incompre- 
hensible existence,  are  presented,  in  these  me- 
moirs, living  and  jumping  before  the  reader. 
Flocks  of  swallows,  blackening  the  air  with  their 
numbers,  abandon  the  joyous,  twittering,  feather- 
chasing  career  of  their  summer  life,  and  with 
ominous  solemnity  assemble  on  the  banks  of 
some  stagnant  pool,  rendered  famous  perhaps 
with  the  tradition  of  former  engulfments  of 
their  species,  and  then  are  seen  no  more.  A 


388  ADDRESS   BEFORE   THE   AMERICAN 

cloud  settles  on  the  mystery  of  their  wintry  ex- 
istence, and  the  wonder  was  that,  when  they  ap- 
peared in  the  following  spring,  their  sleek  and 
glossy  plumage  bore  no  traces  of  the  deep  mud 
under  which  they  were  believed  to  have  slept  out 
their  hybernation. 

The  riches  of  our  vegetable  kingdom  and  the 
importance  of  establishing  a  more  thorough  and 
practical  knowledge  of  its  different  portions,  did 
not  escape  the  attention  of  the  pioneers  of  our 
natural  history.  Great  difficulties  beset  the 
early  botanists  in  the  prosecution  of  their  in- 
quiries, from  the  novelty  of  the  subject,  the  pau- 
city of  books,  and  the  difficulty  of  maintaining 
correspondence  with  foreign  scientific  authori- 
ties, in  those  cases  where  books  are  insufficient 
and  knowledge,  to  a  certain  extent,  must  be 
ocular  and  traditionary.  Yet,  the  Rev.  Dr.  Cut- 
ler, of  our  State,  has  culled  for  himself  an  endur- 
ing garland  from  a  field  in  which  it  would  appear 
that  the  harvest  was  plenteous,  but  the  laborers 
were  few. 

The  valleys  of  New  England  are  not  the  seat 
of  antiquities  and  hieroglyphic  records,  yet,  in 
the  earlier  volumes  of  the  Transactions,  there  is 


ACADEMY   OF  ARTS   AND   SCIENCES.  389 

more  than  one  account  of  the  memorable  inscrip- 
tion on  our  far-famed  Dighton  rock.  This  curi- 
ous relic  of  the  scattered  and  now  fast  disappear- 
ing aboriginal  inhabitants  of  our  country,  is 
copied  and  described  by  various  persons,  and 
hypothetically  explained  by  the  late  excellent 
Judge  Davis,  of  this  city.  "Whatever  be  the 
mystery  it  involves,  a  hunting  scene  or  a  relig- 
ious rite,  an  achievement  of  war  or  of  conquest, 
the  pages  of  the  Academy  offer  a  faithful  fac- 
simile for  the  use  of  foreigners  and  of  posterity, 
who  may  happen  to  find  themselves  called  and 
competent  to  its  perusal. 

But  by  far  the  most  ambitious  among  the  early 
speculations  of  the  Academy  is  the  theory  of 
Governor  Bowdoin,  then  President  of  the  Insti- 
tution, on  the  existence  in  the  universe  of  an  all- 
surrounding  orb.  That  distinguished  gentleman 
and  scholar,  after  various  speculations  on  the 
supposed  waste  of  material  light  from  the  surface 
of  the  sun,  and  the  danger  to  all  material  bodies 
from  their  own  unresisted  gravity  attracting 
them  towards  each  other,  published  an  elaborate 
memoir,  entitled  "  Observations  tending  to  prove 
by  phenomena  and  Scripture,  the  existence  of  an 
33* 


390      ADDRESS  BEFORE  THE  AMERICAN 

orb  which  surrounds  the  visible  material  system, 
and  which  may  be  necessary  to  preserve  it  from 
the  ruin  to  which,  without  such  a  counter- 
balance, it  seems  liable,  by  that  universal  prin- 
ciple in  matter,  gravitation." 

The  author  satisfies  himself,  by  a  train  of  in- 
genious reasoning,  of  the  sufficiency  of  his  theory 
to  prevent  the  apprehended  catastrophe.  He 
deals  not  only  with  the  necessities  of  such  an 
arrangement  to  produce  stability  in  our  universe, 
but  draws  supernumerary  arguments  from  the 
presence  of  the  milky  way,  the  blue  color  of  the 
firmament,  and  lastly  from  various  corroborative 
texts  of  Scripture. 

History  is  silent  in  regard  to  the  extent  of  the 
impression  made  upon  the  world  by  the  promul- 
gation of  this  comprehensive  theory.  The  orb 
is  supposed  to  have  been  standing  several  years 
after  the  announcement  of  its  character  and 
office  ;  and  when  it  fell,  the  Academy,  nothing 
daunted,  proceeded  to  prosecute  its  celestial 
investigations  with  a  zeal  and  tenacity  of  pur- 
pose prophetic  of  its  future  more  elevated 
destiny. 


ACADEMY   OF  ARTS   AND   SCIENCES.  391 


tenacem  propositi 

•  si  fractus  illabatur  orbis 


Impavidum  ferient  ruinse. 

Should  any  one  incline  to  disparage  the  labors 
of  our  predecessors  on  account  of  their  honest 
and  earnest,  though  sometimes  misdirected,  in- 
quiries for  truth,  he  will  find  parallel  examples  in 
the  early  history  of  every  learned  body  in 
Europe  of  a  century's  standing.  The  first  pub- 
lications of  the  oldest  philosophical  societies 
contain  speculations  on  the  transmuting  of 
metals,  projects  for  perpetual  motion,  schemes 
for  raising  water  without  power,  and  for  flying 
in  the  air  by  machinery,  credulous  inquiries 
about  secret  poisons  and  fabulous  natural  pro- 
ductions. They  did  not  think  it  beneath  them 
to  investigate  extravagant  rumors,  and  they 
often  propounded  interrogatories,  with  this  view, 
to  foreign  ambassadors,  missionaries,  merchants 
and  navigators.  The  Royal  Society  of  London 
sent  many  grave  inquiries  to  Sir  Philberto  Yer- 
natti,  then  resident  in  the  Indies,  in  hopes  to 
solve  some  of  the  difficulties  which  were  weigh- 
ing upon  them.  The  first  of  these  was,  "  Whether 
diamonds  and  other  precious  stones  grow  again 


392      ADDRESS  BEFORE  THE  AMERICAN 

after  three  or  four  years  in  the  same  places 
where  they  have  been  digged  out?"  The  cate- 
gorical answer  to  this  question  is,  "  Never." 
Another  inquiry  is,  "  Whether,  in  the  island  of 
Sombrero,  there  be  found  such  a  vegetable  as 
Master  James  Lancaster  relates  to  have  seen, 
which  grows  up  to  a  tree,  shrinks  down  when 
one  offers  to  pluck  it,  and  would  quite  shrink 
unless  held  very  hard?"  Sir  Philberto  replies, 
that  he  "  cannot  meet  with  any  that  ever  heard 
of  such  a  vegetable." 

Again  they  inquire,  "  Whether  the  Indians  can 
so  prepare  that  stupefying  herb  Datura,  that  they 
may  make  it  lie  several  days,  months,  years,  ac- 
cording as  they  will  have  it,  in  a  man's  body, 
and  at  the  end  kill  him  without  missing  half  an 
hour's  time  ?  " 

The  twenty-ninth  question  is,  "  Whether  there 
be  a  tree  in  Mexico  that  yields  water,  wine,  vine- 
gar, oil,  milk,  honey,  wax,  thread  and  needles  ?  " 
The  answer  here  is  more  encouraging:  "The 
cocos-trees  yield  all  this,  and  more." 

In  the  inquisitiveness  and  credulity  which 
marked  these  early  stages  of  scientific  inquiry, 
we  have  at  least  the  gratifying  assurance  that 


ACADEMY   OF  ARTS   AND   SCIENCES.  393 

our  philosophic  fathers  did  not  close  their  ears 
against  the  reception  of  knowledge,  from  what- 
ever quarter  it  might  proceed.  They  were  just 
emerging  from  the  deep  intellectual  darkness 
which  for  long  ages  had  brooded  over  the  world. 
They  were  the  survivors  of  many  generations, 
among  whom  to  inquire  had  been  a  crime,  to 
reason  had  been  a  heresy,  and  to  experiment  a 
satisfactory  evidence  of  intercourse  with  the 
powers  of  darkness.  Secretly,  and  by  stealth  and 
stratagem,  the  germs  of  science  had  here  and 
there  been  nourished  into  visible  life,  but  the  air 
and  the  sunlight  of  heaven  were  denied  to  their 
upward  expanding  tendencies.  And  when  at 
length,  with  the  Reformation,  the  revival  of 
letters  and  the  introduction  of  the  printing-press, 
a  veil  was  lifted  from  the  moral  and  material 
world,  no  wonder  that  inquiring  eyes  were  daz- 
zled and  strong  heads  were  turned  with  the  start- 
ling developments  of  the  solar  system,  the  cir- 
cumnavigation of  the  globe,  and  the  practicable 
intercourse  of  men  and  nations  with  each  other. 

The  comparatively  short  period  during  which 
the  American  Academy  has  existed,  has  been  one 
of  advanced  and  rapid  progress  in  the  history  of 


394      ADDRESS  BEFORE  THE  AMERICAN 

science  throughout  the  world.  It  has  been  the 
era  of  the  Herschels  and  Laplace,  of  Lavoisier 
and  of  Davy,  of  Cuvier,  of  Watt,  and  a  host  of 
gigantic  minds,  whose  conquests  over  unknown 
regions  will  never  be  obliterated  from  the  map 
of  science.  During  this  period  of  progress,  the 
small  number  and  limited  opportunities  of  the 
scientific  men  of  our  own  hemisphere  have  been 
such  as  to  render  them  lookers-on,  recipients  and 
dispensers,  rather  than  originators  of  new  dis- 
covery. For  many  years  the  publications  of  this 
Academy  were  so  sparse  and  inconsiderable  as 
to  induce  serious  question  from  some  foreign 
scientific  bodies,  whether  the  usual  exchange  of 
printed  transactions  were  worth  keeping  up. 
There  was  a  long  period,  during  which  the  late 
venerated  Bowditch  seemed  to  be  the  almost 
solitary  pillar  on  whose  support  the  Academy 
relied  for  its  character  and  position  in  the  philo- 
sophic world.  And  to  his  praise  be  it  said,  that 
while  engaged  in  the  surpassing  labors  which 
have  constituted  the  monument  of  his  living  and 
posthumous  fame,  he  never  shrunk  from  identi- 
fying his  name  with  a  small,  and  then  almost  ob- 
scure institution  of  his  native  country.  Punctual 


ACADEMY   OF  AETS   AND   SCIENCES.  395 

in  his  attendance  on  its  meetings,  earnest  in  his 
appeals  to  the  lagging  industry  of  its  members, 
foremost  in  every  movement  for  its  prospective 
welfare,  pouring  into  its  vacant  pages  the  over- 
flowings of  his  own  exuberant  mind,  he  was  not 
only  a  centre,  but  a  central  fire;  not  only  attract- 
ing but  exciting,  warming,  illuminating  all  within 
the  circle  of  his  influence.  By  his  side  walked 
the  accomplished  Pickering,  laborious,  erudite, 
modest,  a  votary  of  learning  for  its  own  sake, 
whose  capacious  and  cultivated  mind,  affluent  in 
various  lore,  seemed  poor  only  to  his  own  aspir- 
ing and  comprehensive  genius. 

By  these  men,  more  than  all  others,  in  the  day 
of  its  obscurity,  was  this  Academy  cherished  and 
upheld.  They  did  not  feel  authorized  to  boast 
much  of  its  history,  nor  of  its  existing  perform- 
ances. They  were  not  vainglorious  of  their  own 
share  in  whatever  of  reputation  it  might  have 
happened  to  acquire.  But  they  felt  and  expressed 
that  in  it  was  contained  the  germ  of  future  devel- 
opment ;  that  to  a  certain  extent  it  had  books,  and 
endowments,  and  position ;  that  it  was  their  duty 
and  that  of  their  cotemporaries  to  cultivate  its 
capacities,  to  improve  its  condition,  and  at  least 


396  ADDRESS   BEFORE   THE   AMERICAN 

to  preserve  it  unimpaired,  until  the  increasing 
population  and  wealth  in  our  country,  and  cor- 
respondent increase  of  the  men  and  means  of 
science,  should  impart  to  it  a  vigorous  vitality, 
like  that  which  sustains  the  older  institutions  of 
Europe. 

We  do  not  assume  too  much  in  saying  that 
this  period  has  at  length  arrived.  The  thinly 
attended  meetings,  few  and  far  between,  in  which 
a  quorum  was  with  difficulty  convened,  perhaps 
only  to  spend  an  hour  in  debating  a  by-law  or 
electing  a  foreign  fellow,  have  been  replaced  by 
monthly  and  semi-monthly  gatherings,  in  which 
the  time  is  often  too  short  to  give  utterance  to 
the  accumulated  researches  of  the  members. 
The  demand  for  publication  of  new  and  impor- 
tant matter  outstrips  the  limited  resources  of  the 
treasury,  and  now  brings  the  institution  before 
the  public  of  this  city,  a  solicitor  for  the  hearing 
of  its  claims.  What  is  it  that  this  Academy, 
through  its  members,  is  now  performing?  What 
is  it  that  it  asks  the  means  of  publishing  to  the 
world?  Not  the  meagre  and  uninteresting  record 
of  every-day  phenomena.  Not  the  premature 
speculations  of  unqualified  reasoners  on  more 


ACADEMY   OF  ARTS   AND   SCIENCES.  397 

expanded  subjects.  Not  the  repeated  lessons 
received  with  unquestioning  docility  from  the 
higher  sources  of  transatlantic  wisdom.  It  now 
rather  sits  in  judgment  on  unsettled  questions 
of  European  science,  and  pushes  its  own  unaided 
investigations  bej'ond  the  previous  bounds  of 
human  knowledge.  Its  researches  during  the 
last  five  or  six  years  have  been  such  in  magni- 
tude and  importance  that  they  may  without  dis- 
advantage be  brought  into  comparison  with  those 
of  many  of  the  time-honored  institutions  of  the 
Old  "World.  Closely  connected  with  our  distin- 
guished University,  numbering  among  the  teach- 
ers of  that  seminary  a  large  portion  of  its  most 
accomplished  and  efficient  members,  making  the 
pages  of  its  publications  a  vehicle  for  the  light 
which  emanates  from  the  observatory,  the  appa- 
ratus, the  collections  of  that  venerable  seat  of 
learning,  aided  moreover  by  the  naturalists,  the 
philosophers  and  the  annalists  of  other  societies 
among  us,  it  has  established  an  influence  which 
could  not  well  be  now  spared  from  the  republic 
of  science. 

We  may  say,  without  fear  of  contradiction,  that 
there  are  few  branches  of  physical  knowledge 
34 


398      ADDRESS  BEFORE  THE  AMERICAN 

which  have  not  been  illustrated  or  enlarged  by 
the  members  of  this  body,  and  when  difficult 
labors  are  to  be  performed,  or  difficult  problems 
to  be  solved,  no  source  of  information  in  our 
country  has  been  deemed  more  reliable,  or  more 
frequently  been  put  in  requisition,  than  the  au- 
thority of  this  Academy.  The  plants  of  Califor- 
nia and  New  Mexico  have  repeatedly  come  here 
to  be  named  and  described.  The  late  exploring 
expedition  sent  to  this  city  a  large  portion  of  its 
collected  treasures,  for  investigation  and  judg- 
ment. The  fossil  bones  of  gigantic  quadrupeds 
are  accumulated  in  our  midst  with  a  complete- 
ness and  abundance  such  as  is  found  in  no  other 
place  ;  and  they  are  presented  to  the  world  with 
an  amplitude  of  scientific  delineation,  seldom,  if 
ever,  surpassed.  Huge  limbs  and  heads  of  un- 
described  troglodytes,  exceeding  those  of  man 
which  they  counterfeit,  and  whose  race  is  now 
living  in  African  forests,  have  received  their  first 
description  in  this  city. 

The  pages  of  our  Transactions  offer  the  faithful 
impress,  not  elsewhere  found,  of  the  foot-prints 
of  colossal  birds  and  mysterious  reptiles,  trans- 
ferred from  the  banks  of  our  own  rivers,  where, 


ACADEMY   OF   ARTS   AND   SCIENCES.  399 

awaiting  the  perusal  of  the  naturalist,  they  have 
lain  for  unknown  ages,  stereotyped  in  stone.  It 
is  fresh  in  our  recollection,  that  when  the  credu- 
lity of  the  popular  voice,  not  without  the  assent 
of  men  of  science,  had  given  a  fictitious  reality 
to  a  monster  compounded  of  contributions  levied 
from  many  individuals,  and  when  this  deception 
gained  foothold  not  only  in  our  own  greatest 
city,  but  afterwards  in  one  of  the  enlightened 
capitals  of  Germany,  the  doubt  was  removed  and 
the  deception  made  manifest  by  the  scientific 
sentence  of  one  of  this  Academy. 

A  few  years  ago  a  call  was  made  by  the  Legis- 
lature of  this  Commonwealth  for  researches  into 
the  various  departments  of  its  indigenous  natural 
history.  This  call  was  promptly  and  ably  re- 
sponded to,  and  the  reports  returned  on  the 
geology,  the  forest-trees,  the  fishes,  the  insects, 
and  the  other  invertebrata  of  Massachusetts,  were 
in  the  highest  degree  creditable  to  those  acade- 
micians from  whose  labors  they  emanated.  Some 
of  these  subjects  are  yet  waiting  the  results  of 
this  course  of  lectures,  to  give  their  illustrations 
to  the  public. 

The  incipient  mysteries  of   organic  develop- 


400  ADDRESS   BEFORE   THE   AMERICAN 

ment,  the  structure  and  transformations  of  the 
animalcular  world,  the  scarce  visible  organisms 
which  fill  our  waters  with  busy  and  effective  life, 
the  unknown  generations  which  have  written 
with  their  own  remains  the  history  of  preceding 
nature,  have  often  been  drawn  from  obscurity, 
their  laws  and  limits  studied,  and  many  of  their 
new  and  unknown  forms  for  the  first  time  de- 
scribed and  arranged  by  one  of  our  adopted 
members,  whom  we  may  well  place  in  the  fore- 
most rank  of  living  naturalists.  And,  as  if  to 
indicate  the  claim  to  notice  of  what  might  seem 
a  humble  department,  of  zoology,  we  have  been 
taught,  from  the  same  indefatigable  source,  that, 
since  the  period  of  man's  existence  on  this  globe, 
a  vast  peninsula,  constituting  nearly  an  entire 
state  of  this  Union,  has  been  raised  from  the  bot- 
tom of  the  ocean,  and  added  to  the  previous  con- 
tinent, by  the  silent  conspiring  agency  of  coral 
polypes. 

When  we  turn  our  inquiries  in  another  direc- 
tion, we  find  that  the  study  and  knowledge  of 
the  electric  power  has  not  deserted  the  country 
of  Franklin.  This  mighty  agent,  before  which 
men  trembled  in  former  ages,  believing,  in  their 


ACADEMY   OF   AKTS   AND   SCIENCES.  401 

alarm,  that  Jove  was  wielding  his  bolts,  or  "  that 
spirits  were  riding  the  northern  light/'  has  be- 
come, in  philosophic  hands,  the  docile  messenger 
of  thought  over  our  vast  country,  and  the  faith- 
ful monitor  of  danger  in  our  cities,  and  seems 
about  to  reveal  the  very  measure  of  its  velocity 
to  the  persevering  interrogations  of  members  of 
this  Academy. 

I  should  weary  you  with  detail,  were  I  to  re- 
count the  various  contributions  made  among  us 
to  mathematical,  chemical,  economical,  mechanic, 
and  microscopic  science,  and  to  the  natural  his- 
tory of  the  globe  and  of  its  inhabitants.  I  might 
say  that  the  tornado  which  last  year  swept  over 
a  neighboring  district,  has  left  on  our  pages  an 
impress  more  minute  than  ever  whirlwind  left 
before.  I  might  say  that  the  forthcoming  nauti- 
cal almanac,  the  joint  and  arduous  production  of 
our  mathematicians,  will  stand  in  the  foremost 
rank  of  similar  authorities.  I  might  bring  before 
you  the  perfected  turbine  wheel,  and  the  elab- 
orate cordage  machinery,  as  examples  of  the 
mechanical  ability  and  inventive  genius  of  our 
academicians ;  and  I  might  cite  many  instances 
of  energetic  cooperation  with  other  bodies,  in 
34* 


402  ADDRESS   BEFORE   THE   AMERICAN 

the  magnetic  observations,  in  meteorology,  in  the 
coast  survey,  and  in  the  general  advancement  of 
geographical  and^hilosophic  knowledge. 

Conspicuous  above  other  sciences,  for  the  vast- 
ness  of  its  objects,  and  the  amount  of  intellect- 
ual effort -which  it  has  called  into  being,  stands 
Astronomy,  one  of  the  earliest,  the  most  difficult, 
and  most  successful  studies  of  the  human  mind. 
For  many  years  the  discoveries  of  its  observers, 
and  the  results  of  its  analysts,  have,  by  the  com- 
mon consent  of  central  and  northern  Europe, 
been  chronicled  in  one  place,  in  the  city  of 
Altona,  in  the  astronomical  journal  of  the  emi- 
nent Professor  Schumacher.  But  Schumacher 
is  dead,  and  his  divided  mantle  has  fallen  upon 
the  shoulders  of  more  than  one  competent  suc- 
cessor. The  only  journal  in  the  English  lan- 
guage, now  devoted  to  pure  astronomical  sci- 
ence, regularly  reporting,  with  discriminating 
exactness,  the  advances  made  in  that  department 
of  knowledge,  and  enriched  by  contributions 
from  both  sides  of  the  Atlantic,  as  well  as  from 
its  own  editor,  is  now  published  in  this  country, 
and  issues  periodically  from  the  press  of  Cam- 
bridge in  Massachusetts. 


ACADEMY   OF   ARTS   AND   SCIENCES.  403 

It  has  not  been  in  vain  that  public  liberality 
has  provided  our  University  with  instruments 
capable  of  penetrating  the  depths  of  space.  It 
has  found  in  that  place  eyes  adequate  to  per- 
ceive, and  minds  competent  to  analyze,  the  ab- 
struser  revelations  of  astronomical  science.  The 
meetings  of  this  Academy  have  heard  the  an- 
nouncement of  new  celestial  bodies,  and  the  as- 
signment of  unexpected  laws  to  others  already 
familiar  to  the  European  world.  Who  is  there, 
from  the  schoolboy  to  the  sage,  who  has  not 
dwelt  and  gazed  and  speculated  on  the  mysteri- 
ous ring  that  surrounds  the  planet  Saturn?  Who 
has  not  wondered  at  this  exceptional  feature  of 
the  known  universe,  and  planted  himself  in  imag- 
ination on  the  surface  of  that  distant  sphere,  that 
he  might  seem  to  contemplate  the  radiant  arch 
that  spanned  its  unknown  firmament  ?  Yet  this 
remaining  anomaly  of  the  visible  creation,  this 
marvel  and  study  of  modern  astronomy,  has  been 
destined  to  reveal  its  structure  at  our  own  ob- 
servatory. And  the  necessity  of  its  fluid  nature, 
and  the  laws  by  which  it  is  sustained,  have  been 
deduced  from  the  observations,  and  established 
by  the  profound  analysis,  of  our  own  astronomers. 


404  ADDRESS  BEFORE  THE   AMERICAN 

Need  I  call  up  before  this  audience  the  recent 
fame  of  that  far  ulterior  planet,  which,  since  the 
creation  of  the  world,  has  held  its  dim  and  unde- 
tected course  around  the  verge  of  our  solar 
system,  until  at  length  its  remote  presence  so 
weighed  upon  the  instructed  sense  of  the  Paris- 
ian philosopher,  that  it  was  felt  and  known  even 
before  it  was  seen  ?  And  need  I  say  that  this 
object  of  absorbing  interest,  this  wonder  of  its 
time,  after  justifying  in  some  measure  the  rival 
claims  to  its  discovery  of  the  three  most  enlight- 
ened nations  of  Europe,  came  at  last  to  receive 
the  determination  of  its  true  orbit,  position,  mass 
and  motion,  from  the  geometers  of  our  own 
Academy  ? 

I  have  said  enough  to  show  that  the  Ameri- 
can Academy  of  Arts  and  Sciences  has  earned  for 
itself  a  position  among  similar  institutions  of  the 
world;  and  although,  from  the  necessary  limits  of 
the  occasion,  I  have  not  been  able  to  take  fitting 
notice  of  other  investigations  made  here  for  the 
advancement  of  knowledge  and  other  worthy 
achievements  in  the  parallel  walks  of  literature, 
yet  without  arrogance  I  might  assert  that,  in  the 
different  sections  of  this  Academy,  embracing  the 


ACADEMY   OP  ARTS  AND   SCIENCES.  405 

great  departments  of  modern  research  and  culti- 
vation, men  are  now  found  competent  to  perceive 
truth,  and  qualified  to  return  light,  on  the  varied 
objects  of  human  science. 

It  is  not  necessary  to  say  that  the  meetings  of 
such  a  body  afford  a  nucleus,  around  which  are 
attracted  and  concentrated  the  contributions  of 
most  of  our  scientific  men.  And  the  regularly 
published  proceedings  of  this  body  are  the  vehicle 
through  which  are  given  to  the  world  the  results 
of  their  labors. 

It  ought  not  then  to  be  said  that,  in  this  en- 
lightened community,  the  efforts  of  so  active  and 
efficient  an  institution  should  be  embarrassed  by 
financial  deficiencies.  Yet  such  is  the  uniform 
excess  of  its  expenditures  over  its  limited  income, 
that  the  Academy  is  not  able  to  procure  the  books 
wanted  for  the  information  of  its  members,  nor  to 
issue  the  publications  which  should  give  utter- 
ance to  its  own  investigations.  So  far  from  enjoy- 
ing the  promptness  and  amplitude  of  appearance 
which  attend  the  productions  of  similar  institu- 
tions abroad,  it  has  happened,  more  than  once, 
that  the  discoveries  of  our  scientific  men  have 
had  to  wait,  until  they  were  actually  superseded 


406  ADDRESS   BEFORE   THE  AMERICAN 

by  the  same  discoveries  abroad,  because  the 
printed  pages  and  the  illustrations  of  the  engraver 
could  not  be  commanded  at  the  requisite  time. 

As  a  nation  we  are  proud  of  whatever  contrib- 
utes to  our  national  glory.  We  are  boastful  of 
our  growth,  our  political  progress,  our  victories, 
our  annexations.  We  are  proverbially  sensitive, 
even  in  small  matters,  to  questions  of  precedence 
and  subordination,  and  we  give  our  undivided 
sympathy  even  to  a  national  contest  of  lock- 
smiths. The  triumph  of  nautical  skill  in  a  distant 
boat-race  binds  this  Union  more  firmly  together, 
by  the  common  thrill  of  exultation  which  vibrates 
from  Maine  to  Texas. 

Have  we  then  no  place  for  the  rising  star  of 
science?  Shall  we  avert  our  eyes  from  the  dawn- 
ing light,  because  its  rays  do  not  fall  on  us  from 
the  accustomed  east  ?  Have  we  no  encourage- 
ment for  those,  our  countrymen,  to  whom  the  Old 
World  is  beginning  to  yield  its  reluctant  honors  ? 
Are  we  incapable  of  appreciating  the  value  of 
scientific  progress,  and  the  importance  that  our 
own  country  should  not  be  last  in  the  general 
march  of  improvement  which  characterizes  the 
present  age  ?  Such  has  not  been  the  character 


ACADEMY   OF   AETS   AND   SCIENCES.  407 

and  usage 'of  this  our  city.  Such  could  not  have 
been  the  expectation  of  those  who,  in  adverse 
times,  planted  and  nourished  among  us  seeds 
capable  of  a  redundant  harvest. 

I  have  thus,  ladies  and  gentlemen,  endeavored 
to  present  to  your  favorable  notice  the  character 
and  claims  of  the  Academy  of  Arts  and  Sciences. 
In  the  course  of  lectures  which  is  to  follow,  the 
Academy  will  speak  for  itself.  I  am  aware  that 
it  is  presumptuous  for  one  absorbed  in  the  cares 
of  a  responsible  profession,  who  has  added  little 
to  the  common  storehouse  of  indigenous  science, 
to  appear  as  the  advocate  and  representative  of 
so  distinguished  a  body.  But  I  am  impressed 
with  the  importance  of  the  occasion,  and  obey 
the  commands  which  have  been  laid  upon  me  ; 
and  I  will  shelter  myself  under  the  belief  that  it 
may  sometimes  be  permitted,  even  to  the  drone 
in  the  hive,  to  cause  the  air  to  vibrate  in  honor 
of  the  labors  of  his  more  efficient  colleagues. 


INDEX. 


Page 

ABSTINENCE  in  Diet 145 

Academy,  American,  Address,  375 
Acute  Rheumatism,  ....  36 
Amphoric  Resonance,  ....  245 
Anatomy  and  Surgery,  ...  98 


Epilepsy, 33 

Erysipelas, 24 

Esculapius, 3(56 

Etiology, 97 

Exact  Sciences, 64 


Andre,  Major, 194    Exaggeration,  Medical,  ...    99 

Angina  Pectoris, 33  '  Expectant  Practice,     ....  106 

Ascarides, 58  | 

Auburn,  Mount, 176  j  Fire,  Injuries  by, 151 


Blane,  Sir  Gilbert, 49 

Borromeo,  Carlo, 192 

Botanic  Practitioners,  .  .  .  108 
Bowditch,  Nathaniel,  ....  394 
Burial  of  the  Dead,  ....  176 
Burns  and  Scalds, 151 

Caligo, 204 

Causes,  Removal  of,     ....    63 

Chalk  Stones, 137 

Charles  I.,  King, 183 

Chemistry, 96 

Cholera, 147 

Clot  Bey, 80 

Cochituate  Water, 329 

Coffee, 306 

Colchicum, 144 

Cutaneous  Diseases,     ....    35 


Gout, 57, 134 

Grecian  Medicine, 362 

Harmony  among  Physicians,    1 24 
Henry  VIII.,  King,     ....  183 

Herculaneum, 208 

History  of  Medicine,  ....  358 

Homoeopathy, 104 

Hooping  Cough, 22 

Incurable  Diseases, 92 

Inefficacy  of  Treatment,     .    .    80 

Kentish,  Mr., 153 

Kinglake,  Dr., 154 

Kings,  Relics  of, 181 

Lead,  Exposure  to, 329 

Lead  Pipes  for  \Yater,     .    .    .  I!  29 
Lectures,  Medical, 101 


Definition  of  Medicine,  ...  69 

Detrimental  Practice,  .    ...  51  j  Louis, 45 

Detrimental  Remedies,    ...  86 

Diagnosis, 72 


Earle,  Sir  James, 154 

Education,  Medical,     ....    95 

Edward  I.,  King 180 

Egyptian  Medicine,     ....  374 

Electricity 400 

Elephant,  Frozen, 189 

35 


Materia  Medica, 97 

Measles, 22 

Medical  Education,  ....  95 
Medical  Profession,  .  .  .  .113 
Medical  Reasoning,  ....  41 

Metallic  Tinkling, 212 

Mctastatic  Diseases,  ....  35 
Mount  Auburn, 176 


410 


INDEX. 


Mncnna  Prnrienn, 281 

Mummies,  Egyptian 191 

Neptune,  Planet 404 

Nomenclature, 252 

Numerical  Method,     ....    45 

Organic  Remains, 400 

Paroxysmal  Diseases,  ....    33 
Partridge,  Poison  ot,  .    .    .    .  287 

Pathology, 97 

Pestilential  Epidemics,    .    .  37,  60 
Pharmacopoeia,  American, .    .  246 

Pickering,  John, 395 

Plague  at  Cairo, 80 

Pliny,  Death  of, 199 

Poison  Sumacs, 137 

Pompeii 207 

Pneumothorax, 210 

Practical  Medicine, 67 

Precocious  Habits, 113 

Priestly  Medicine,    ....  ,.472 
Private  Schools, 7102 

Quackery,.    ......  111,127 

Babbits,  Experiments  on,  .    .  167 


Rational  Praotioe, 41 

Remedies, 61 

Remedies,  Excessive,  ....  86 
Rheumatism,  Acute,  ....  39 
Rhus  vernix,  etc., 131 

Scarlet  Fever, 23 

Self-limited  Diseases 13 

Small-Pox, 24 

Success  of  Treatment,      ...  38 

Sumacs,  Poisonous, 137 

Symptoms,  Prescribing  fi>r,     .  34 

Syphilis, 52 

Tanquerel  on  Lead, 332 

Tea, 312 

Textures,  Susceptibility  of,     .  281 

Theories  in  Medicine 121 

Thompsonian  Sect, 108 

Tobacco,  History  of 344 

Treatment  of  Disease,  ...  64 
Typhoid  Fever,  .' 26 

Vesuvius, 199 

Vinous  Liquors, 140 

Watch,  Illustration  by,  ...    74 


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